DR. MICHAEL T STACK (NPI# 1770585945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770585945 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL T STACK |
| Credential | MD PHD |
| Practice Address |
2845 Greenbrier Rd Green Bay WI 54311 |
| Mailing Address |
3301 W Forest Home Ave Milwaukee WI 53215-2843 |
| Practice Telephone | 9202888100 |
| Practice Fax Number | 9202888153 |
| Mailing Telephone | 4143892338 |
| Mailing Fax Number | 4143858987 |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2019-08-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1744R1102X |
Specialist Specialization: Research Study |
01026374 | IN | Other Service Providers |
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
71508 | WI | Allopathic & Osteopathic Physicians |
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
01026374 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BLUE CROSS BLUE SHIELD | 000000318888 | 01 |
| WI | 100083069 | 05 | |
| IN | 100133510B | 05 | |
| OFFICE/GROUP NPI | 1265457774 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6447 S East St Ste A, Indianapolis, IN 462272119 | 3178596364 | 3178597537 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316943301 | Michael Lee Stack | Obstetrics & Gynecology | 3265 W Sarazens Cir Ste 101, Memphis, TN 38125-0806 | 2005-06-23 |
| 1932146685 | Michael Andrew Stack | Family Medicine | 121 N Pine River St, Ithaca, MI 48847-1039 | 2006-06-01 |
| Street Address |
2845 GREENBRIER RD |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265435853 | Cynthia L Geocaris | Surgery | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2005-05-27 |
| 1659978872 | Molly Linzmeier | Registered Nurse | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-10-01 |
| 1588279756 | Toni M Pullen | Massage Therapist | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-09-14 |
| 1700413283 | Michelle Yvonne Degrave | Registered Nurse | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-03-25 |
| 1588299697 | Amanda Marie Steinfeldt | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-03-09 |
| 1659906113 | Kelly Jane Delzer | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-03-05 |
| 1750915815 | Jennifer Maronek | Occupational Therapist | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-02-27 |
| 1538792379 | Sierra R Milosch | Occupational Therapist | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-02-20 |
| 1205473584 | Mackenzie L Zuleger | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2019-12-05 |
| 1588214860 | Jessica S Thompson | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2019-09-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| Taxonomy Code | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023243805 | Paul Vernon Tuttle Iv | Internal Medicine | 2223 Lime Kiln Rd, Ste 1, Green Bay, WI 54311-6213 | 2009-05-21 |
| 1811030067 | Dana R Trotter | Internal Medicine | 3263 Eaton Rd, Green Bay, WI 54311-6830 | 2007-02-15 |
| 1720165772 | Mark Embrey Davis | Internal Medicine | 2223 Lime Kiln Rd, Suite 1, Green Bay, WI 54311-6213 | 2006-11-01 |
| 1700977030 | Alan G Finesilver | Internal Medicine | 2253 W Mason St, #200, Green Bay, WI 54303-4706 | 2006-09-28 |
| 1326065368 | Paul C Utrie | Internal Medicine | 2223 Lime Kiln Rd, Suite 1, Green Bay, WI 54311-6213 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073755468 | Lon Allen Blaser | Internal Medicine | 3304 Evergreen Ln, Eau Claire, WI 54701-5912 | 2009-03-31 |
| 1750544193 | Walter Roach Sundstrom | Internal Medicine | 404 Orchard Dr, Madison, WI 53711-1315 | 2008-07-07 |
| 1104001098 | Lakeshore Rheumatology, LLC | Internal Medicine | 377 W Riverwoods Parkway, Suite 190, Glendale, WI 53212 | 2008-01-09 |
| 1154527455 | Rheumatology and Immunotherapy | Internal Medicine | 4225 W Oakwood Park Ct, Franklin, WI 53132-8131 | 2007-06-23 |
| 1881803658 | Robina Naz Chowdhery | Internal Medicine | 9697 Saint Catherines Dr # 400, Pleasant Prairie, WI 53158-2118 | 2007-05-21 |
| 1013125186 | Tom M Murphy | Internal Medicine | 1848 Raintree Ln, Racine, WI 53406-7638 | 2007-05-20 |
| 1134234859 | Alvin F Wells | Internal Medicine | 4225 W Oakwood Park Court, Franklin, WI 53132 | 2006-08-20 |
| 1740227669 | Indravadan Kansari | Internal Medicine | 1020 Kabel Ave, Rhinelander, WI 54501-3918 | 2006-05-31 |
| 1306890470 | Milwaukee Rheumatology Center, Sc | Internal Medicine | 2901 W Kinnickinic River Pkwy, Suite 301, Milwaukee, WI 53215-3660 | 2006-05-21 |
| 1932162658 | Allan L Goldman | Internal Medicine | 2801 W Kk River Prkwy, Suite 375, Milwaukee, WI 53215-3678 | 2006-04-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.