Organization
CRYSTAL LAKE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD C NIELSEN MD (PRESIDENT)
(231) 882-9661
Entity
Organization
Contact information
Practice address
115 E 7TH ST, MANTON, MI 49663-9429
(231) 824-4100
(231) 824-4108
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
10/29/2012
Last updated
10/29/2012
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