Provider Demographics
NPI:1215823539
Name:STACK, MICHAEL (EP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STACK
Suffix:
Gender:X
Credentials:EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9719
Mailing Address - Country:US
Mailing Address - Phone:734-788-4595
Mailing Address - Fax:
Practice Address - Street 1:4710 S STATE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9719
Practice Address - Country:US
Practice Address - Phone:734-788-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist