CRYSTAL LAKE CLINIC, P.C. (NPI# 1316177611) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316177611 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE CLINIC, P.C. |
| Practice Address |
2283 E M 113 Kingsley MI 49649-9370 |
| Mailing Address |
6227 Frankfort Hwy Benzonia MI 49616-8632 |
| Practice Telephone | 2318829661 |
| Practice Fax Number | 2318829616 |
| Mailing Telephone | 2318829661 |
| Mailing Fax Number | 2318829616 |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2018-11-06 |
| Authorized Official Name | RICHARD C 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417386145 | Crystal Lake Clinic, P.C. | Family Medicine | 9975 W Ottawa Ave, Empire, MI 49630-9618 | 2013-11-04 |
| 1902851777 | Crystal Lake Clinic, P.C. | Family Medicine | 8225 Lake St, Bear Lake, MI 49614-9688 | 2006-05-23 |
| Street Address |
2283 E M 113 |
| City | KINGSLEY |
| State | MI |
| Zip Code | 49649-9370 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710119847 | Jenna Lynn Stump | Physician Assistant | 2283 E M 113, Kingsley, MI 49649-9370 | 2009-08-24 |
| 1811495666 | Clear Sky Counseling, P.C. | Social Worker | 2283 E M 113, Kingsley, MI 49649-9370 | 2018-01-26 |
| 1568842052 | Anna Cox | Registered Nurse | 2283 E M 113, Kingsley, MI 49649 | 2015-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346742053 | Carlene Brown | Physical Therapist | 850 Brewster Trl, Kingsley, MI 49649 | 2018-03-08 |
| 1063926756 | Cheryl Sue Dann | Social Worker | 2283 M-113 E, Kingsley, MI 49649 | 2017-11-17 |
| 1386168854 | Lori Rachelle Metcalf-rodes | Counselor | 5081 Walton Road, Kingsley, MI 49649 | 2017-07-27 |
| 1356891865 | David Erik Richard Burke | Dentist | 116 W Main St., Kingsley, MI 49649 | 2016-10-07 |
| 1366766081 | Kimberly Anne Michels | Nurse Practitioner | 112 S. Brownson Ave, Kingsley, MI 49649 | 2010-03-24 |
| 1528382538 | Grand Traverse County Health Department | Clinic/Center | 112 S Brownson Ave, Kingsley, MI 49649 | 2010-03-19 |
| 1477739571 | Rnc Medical Supplies | Durable Medical Equipment & Medical Supplies | 9437 Church St, Kingsley, MI 49649 | 2008-01-18 |
| 1740369446 | The Lighthouse - Traverse City, LLC | Clinic/Center | 4140 Beacon St, Kingsley, MI 49649 | 2006-11-03 |
| 1649359316 | The Lighthouse - Traverse City, LLC | Custodial Care Facility | 4140 Beacon St, Kingsley, MI 49649 | 2006-11-03 |
| 1558381509 | Michael Zaleski | Pharmacist | 114 S. Brownson Ave, Kingsley, MI 49649-0247 | 2006-07-20 |
| Find all providers in zip 49649 | ||||
| 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 |
|---|---|---|---|---|
| 1427037829 | David Gene Wright | Family Medicine | 7401 Walton Rd, Kingsley, MI 49649-8211 | 2006-01-13 |
| 1528002938 | Charles E. Hamm | Family Medicine | 111 Main St, Kingsley, IA 51028-7725 | 2006-06-15 |
| 1932142015 | Robert V. Powell | Family Medicine | 111 S Main St, Kingsley, IA 51028-5021 | 2006-06-14 |
| 1003869058 | Jeffrey D. Krohn | Family Medicine | 111 S Main St, Kingsley, IA 51028-5021 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578163465 | Salta of Auburn Hills | Family Medicine | 2191 S South Blvd, Suite 101c, Pontiac, MI 48326-3481 | 2020-10-29 |
| 1396342606 | Kiwi Virtual Health Care Pllc | Family Medicine | 40618 Blythefield Ln, Canton, MI 48188-2251 | 2020-10-08 |
| 1447867619 | Bashar Yalldo Md Plc | Family Medicine | 14700 Farmington Rd Ste 105, Livonia, MI 48154-5434 | 2020-09-30 |
| 1245847342 | Nuha Bakkal | Family Medicine | 1422 Mill Pond Dr, Waterford, MI 48327-3088 | 2020-09-23 |
| 1710592050 | Chippewa County War Memorial Hospital Inc | Family Medicine | 391 E M 134, Cedarville, MI 49719-9451 | 2020-09-14 |
| 1184238966 | Med Clubs | Family Medicine | 2575 Hummingbird Dr, Holt, MI 48842-9430 | 2020-08-31 |
| 1457961054 | Danna Zevy | Family Medicine | 107 S Washington Ave Apt 401, Saginaw, MI 48607-1258 | 2020-08-07 |
| 1194342808 | Zachary Hillman Do Pllc | Family Medicine | 1794 N Lapeer Rd Ste A, Lapeer, MI 48446-7664 | 2020-06-29 |
| 1336765445 | Spectrum Health United | Family Medicine | 7188 Avenue B, Vestaburg, MI 48891-9502 | 2020-06-24 |
| 1477179711 | Spectrum Health United | Family Medicine | 1324 N County Line Rd, Blanchard, MI 49310-9303 | 2020-06-23 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CRYSTAL LAKE CLINIC, P.C..
| 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.