Crystal Lake Clinic P.c.

NPI #1770537748 in Frankfort, Michigan

Provider Information

NPI Number: 1770537748
Entity Type: Organization
Organization Name: Crystal Lake Clinic P.c.
Primary Specialty: Family Medicine
Enumeration Date: May 22, 2006
Last Updated: Jan 27, 2011

Practice Location

Address: 826 FOREST AVE
City: Frankfort
State: Michigan
ZIP Code: 49635-9003
Phone: (231) 352-5285

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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