CRYSTAL LAKE CLINIC P.C. NPI 1417386145

NPI Information

NPI: 1417386145
Provider Name: CRYSTAL LAKE CLINIC, P.C.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
9975 W OTTAWA AVE
EMPIRE, MI
ZIP 49630
Phone: (231) 882-9616
Get Directions

CRYSTAL LAKE CLINIC, P.C. is a family medicine in Empire, 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, P.C. NPI is 1417386145. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

9975 W OTTAWA AVE
EMPIRE, MI
ZIP 49630-618
Phone: (231) 882-9616

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 enumeration date for this NPI number is 11/4/2013 and was last updated on 11/4/2013.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0N38430	MEDICARE PIN	MICHIGAN

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: 5/5/2024

NPI Synchronization or Removal

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