Organization
CRYSTAL LAKE CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD NIELSEN MD (PRESIDENT)
(231) 882-9661
Entity
Organization
Contact information
Practice address
9975 W OTTAWA AVE, EMPIRE, MI 49630-9618
(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
11/04/2013
Last updated
11/04/2013
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