Crystal Lake Clinic, P.c.

NPI #1316177611 in Kingsley, Michigan

Provider Information

NPI Number: 1316177611
Entity Type: Organization
Organization Name: Crystal Lake Clinic, P.c.
Primary Specialty: Family Medicine
Enumeration Date: Jul 21, 2009
Last Updated: Nov 6, 2018

Practice Location

Address: 2283 E M 113
City: Kingsley
State: Michigan
ZIP Code: 49649-9370
Phone: (231) 882-9661

Authorized Official

Name: RICHARD C NIELSEN, M.D.
Title: PRESIDENT
Phone: (231) 882-9661

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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