Organization
CRYSTAL LAKE CLINIC, PC
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
5191 ROSEWOOD DR, TRAVERSE CITY, MI 49685
(231) 882-9661
Mailing address
6227 FRANKFORT HWY, BENZONIA, MI 49616-8632
(231) 882-9661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/20/2012
Last updated
05/02/2017
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