Crystal Lake Clinic, P.c.

NPI #1902851777 in Bear Lake, Michigan

Provider Information

NPI Number: 1902851777
Entity Type: Organization
Organization Name: Crystal Lake Clinic, P.c.
Primary Specialty: Family Medicine
Enumeration Date: May 23, 2006
Last Updated: Nov 6, 2018

Practice Location

Address: 8225 LAKE ST
City: Bear Lake
State: Michigan
ZIP Code: 49614-9688
Phone: (231) 864-3314

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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