Mountain Lake Medical Grp PC
NPI #1588973788 in Pollock Pines, California
Provider Information
- NPI Number
- 1588973788
- Entity Type
- Organization
- Organization Name
- Mountain Lake Medical Grp PC
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Oct 5, 2010
- Last Updated
- Feb 16, 2012
Practice Location
- Address
- 6156 PONY EXPRESS TRL
- City
- Pollock Pines
- State
- California
- ZIP Code
- 95726-9649
- Phone
- (530) 644-6044
Authorized Official
- Name
- WILLIAM MICHAEL CULVER, M.D.
- Title
- CEO/PHYSICIAN
- Phone
- (530) 644-6044
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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