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
1225 W FRONT ST, SUITE C, TRAVERSE CITY, MI 49684-2368
(231) 715-3601
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
07/18/2015
Last updated
07/18/2015
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