Organization
CRYSTAL LAKE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD NIELSEN M.D. (PRESIDENT)
(231) 882-9661
Entity
Organization
Contact information
Practice address
1806 E PARKDALE AVE STE 2, MANISTEE, MI 49660-9364
(231) 882-9661
Mailing address
6227 FRANKFORT HWY, BENZONIA, MI 49616-8632
(231) 882-9661
(231) 882-9616
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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