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CRYSTAL LAKE CLINIC PC NPI 1134491731


NPI Information

NPI: 1134491731
Provider Name: CRYSTAL LAKE CLINIC PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 23D2134178

Address:
1806 E PARKDALE AVE STE 2
MANISTEE, MI
ZIP 49660
Phone: (231) 882-9661
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CRYSTAL LAKE CLINIC PC is a family medicine in Manistee, MI. The provider is 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. CRYSTAL LAKE CLINIC PC NPI is 1134491731. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1806 E PARKDALE AVE STE 2
MANISTEE, MI
ZIP 49660-364
Phone: (231) 882-9661

The provider's authorized official is Richard Nielsen .
The authorized official title is President and has the following contact phone number (231) 882-9661.

The CLIA number assigned to this NPI record is 23D2134178 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/30/2012 and was last updated on 1/30/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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