23D2134178 CLIA NUMBER - CRYSTAL LAKE CLINIC, P C

Laboratory Demographics

CLIA Number: 23D2134178

Facility Name: CRYSTAL LAKE CLINIC, P C

Facility Address:
650 S WEST BAY SHORE DRIVE
SUTTONS BAY, MI
ZIP 49682
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Facility Phone Number: 231 882-9661

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134491731

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	23D2134178
LAB Type	Physician Office
Facility Name	CRYSTAL LAKE CLINIC, P C
Street	650 S WEST BAY SHORE DRIVE
City	SUTTONS BAY
State	MI
ZIP	49682
Phone	231 882-9661
CertificateType	4
CertificateEffectiveDate	7/27/2023
CertificateExpirationDate	7/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024