CRYSTAL LAKE CLINIC PC (NPI# 1134491731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134491731 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE CLINIC PC |
| Practice Address |
1806 E Parkdale Ave Ste 2 Manistee MI 49660-9364 |
| Mailing Address |
6227 Frankfort Hwy Benzonia MI 49616-8632 |
| Practice Telephone | 2318829661 |
| Mailing Telephone | 2318829661 |
| Mailing Fax Number | 2318829616 |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |
| Authorized Official Name | RICHARD NIELSEN (PRESIDENT) |
| Authorized Official Telephone | 2318829661 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
1806 E PARKDALE AVE STE 2 |
| City | MANISTEE |
| State | MI |
| Zip Code | 49660-9364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083192306 | Margaret R Batzer | Acupuncturist | 352 1st St, Manistee, MI 49660 | 2018-07-30 |
| 1821590373 | Esther Sigurdardottir | Physical Therapist | 1465 E. Parkdale Av, Manistee, MI 49660 | 2018-03-01 |
| 1104328657 | Bryan Keith Kidd | Physical Therapist | 1465 Parkdale Avenue, Manistee, MI 49660 | 2018-03-01 |
| 1790153799 | Deborah Ann Brandt | Registered Nurse | 318 River Street, Friends Who Care, Manistee, MI 49660 | 2015-09-08 |
| 1265811624 | Joyce Eileen Copeland | Assisted Living Facility | 3644 Chippewa Hwy, Manistee, MI 49660 | 2015-05-19 |
| 1275927931 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 16 Caberfae Hwy, Manistee, MI 49660 | 2015-03-20 |
| 1518244912 | Mara Lane Mckinley | Nurse Practitioner | 1465 E. Parkdale Ave3., Manistee, MICHIGAN 49660 | 2011-11-14 |
| 1477749406 | Catherine Imelda Oertel | Social Worker | 2198 Us 31 South, Manistee, MI 49660 | 2007-09-24 |
| 1811109051 | Goodwill Optical Inc | Optometrist | 282 12th St, Manistee, MI 49660 | 2007-05-03 |
| 1144364381 | Layne Christopher Godzina | Dentist | 422 First Street, Manistee, MI 49660 | 2007-02-19 |
| Find all providers in zip 49660 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295845469 | Paul Joseph Antal | Family Medicine | 72 Filer St, Manistee, MI 49660-2717 | 2006-08-30 |
| 1114901576 | Brian Jay Mccomb | Family Medicine | 1400 E Parkdale Ave, Suite #4, Manistee, MI 49660-9776 | 2005-11-30 |
| 1477559888 | Jeffrey Elliott Kittle | Family Medicine | 148 Parkdale Ave, Manistee, MI 49660-1128 | 2005-06-22 |
| 1750386199 | Scott Allan Carlson | Family Medicine | 2198 Us 31 S, Manistee, MI 49660 | 2005-06-14 |
| 1336657139 | North Forest Family Practice, Pllc | Family Medicine | 428 1st St, Manistee, MI 49660-1595 | 2018-01-15 |
| 1124415666 | Indigo Hospital Medicine - Manistee, Plc | Family Medicine | 1400 E Parkdale Ave, Manistee, MI 49660-9776 | 2015-04-22 |
| 1891112819 | Danielle Marie Olson-basora | Family Medicine | 1400 E Parkdale Ave, Manistee, MI 49660-9776 | 2014-03-27 |
| 1841410941 | William F Lange | Family Medicine | 1465 E Parkdale Ave, Manistee, MI 49660-9709 | 2007-04-30 |
| 1598984387 | Maxine Anne Lipon | Family Medicine | 2198 Us 31 S, Manistee, MI 49660-9618 | 2007-04-24 |
| 1356472872 | Lakeshore Family Care, PC | Family Medicine | 72 Filer St, Manistee, MI 49660-2717 | 2007-03-08 |
| Find all providers in MANISTEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.