| Crystal Lake Clinic P.c. | |
|
4025 Chums Village Dr Traverse City MI 49685-6992 | |
| (231) 715-3613 | |
| Not Available |
| Full Name | Crystal Lake Clinic P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4025 Chums Village Dr, Traverse City, Michigan |
| Authorized Official Name and Position | Richard C Nielsen (PRESIDENT) |
| Authorized Official Contact | 2318829661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Lake Clinic P.c. 6227 Frankfort Hwy Benzonia MI 49616-8632 Ph: (231) 882-9661 | Crystal Lake Clinic P.c. 4025 Chums Village Dr Traverse City MI 49685-6992 Ph: (231) 715-3613 |
| NPI Number | 1376927756 |
|---|---|
| Provider Enumeration Date | 07/15/2015 |
| Last Update Date | 07/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376927756 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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