CRYSTAL LAKE CLINIC P.C. NPI 1902851777

NPI Information

  • NPI: 1902851777
  • Provider Name: CRYSTAL LAKE CLINIC, P.C.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 23D0892491
  • Address: 8225 LAKE ST
    BEAR LAKE, MI
    ZIP 49614
  • Phone: (231) 864-3314

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NPI Details

CRYSTAL LAKE CLINIC, P.C. is a family medicine in Bear Lake, 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 1902851777. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

8225 LAKE ST
BEAR LAKE, MI
ZIP 49614-688
Phone: (231) 864-3314

The provider's authorized official is Richard C 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 23D0892491 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/23/2006 and was last updated on 11/6/2018.

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
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: 11/21/2025

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