Organization
MOUNTAIN LAKE MEDICAL GRP PC
Active
Other names
William Michael Culver MD
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MICHAEL CULVER M.D. (CEO/PHYSICIAN)
(530) 644-6044
Entity
Organization
Contact information
Practice address
6156 PONY EXPRESS TRL, POLLOCK PINES, CA 95726-9649
(530) 644-6044
(530) 644-0125
Mailing address
6156 PONY EXPRESS TRL, POLLOCK PINES, CA 95726-9649
(530) 644-6044
(530) 644-0125
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
G32582
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4774218
—
CA
Enumeration date
10/05/2010
Last updated
02/16/2012
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