Organization
CRYSTAL LAKE CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD C NIELSEN M.D. (PRESIDENT)
(231) 882-9661
Entity
Organization
Contact information
Practice address
2283 E M 113, KINGSLEY, MI 49649-9370
(231) 882-9661
(231) 882-9616
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
07/21/2009
Last updated
11/06/2018
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