CRYSTAL LAKE CLINIC P.C. (NPI# 1164945978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164945978 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE CLINIC P.C. |
| Practice Address |
650 S West Bay Shore Dr Suttons Bay MI 49682-9587 |
| Mailing Address |
6227 Frankfort Hwy Benzonia MI 49616-8632 |
| Practice Telephone | 2318829661 |
| Mailing Telephone | 2318829661 |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-07-24 |
| Authorized Official Name | RICHARD C NIELSEN (PRESIDENT) |
| Authorized Official Telephone | 2318829661 |
| Authorized Official Credential | MD |
| 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 |
|---|---|---|---|---|
| 1386028769 | Crystal Lake Clinic P.C. | Family Medicine | 6170 Us Highway 31 N, Williamsburg, MI 49690-9306 | 2015-07-15 |
| 1417902057 | Crystal Lake Clinic P.C. | Pediatrics | 1975 Stirling Dr, Interlochen, MI 49643-9264 | 2006-05-23 |
| 1770537748 | Crystal Lake Clinic P.C. | Family Medicine | 826 Forest Ave, Frankfort, MI 49635-9003 | 2006-05-22 |
| 1053780072 | Crystal Lake Clinic P.C. | Family Medicine | 124 Ames St, Elk Rapids, MI 49629-9449 | 2015-09-21 |
| 1679957617 | Crystal Lake Clinic P.C. | Family Medicine | 1225 W Front St, Suite C, Traverse City, MI 49684-2368 | 2015-07-18 |
| 1376927756 | Crystal Lake Clinic P.C. | Family Medicine | 4025 Chums Village Dr, Traverse City, MI 49685-6992 | 2015-07-15 |
| 1538543913 | Crystal Lake Clinic P.C. | Family Medicine | 1213 W Front St, Traverse City, MI 49684-2317 | 2015-07-15 |
| 1316991755 | Crystal Lake Clinic P.C. | Internal Medicine | 6227 Frankfort Hwy, Benzonia, MI 49616-9654 | 2006-05-20 |
| Street Address |
650 S WEST BAY SHORE DR |
| City | SUTTONS BAY |
| State | MI |
| Zip Code | 49682-9587 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437228301 | Mark A Priest Do PC | Family Medicine | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2006-11-07 |
| 1588083836 | Leelanau Urgent Care, PC | Clinic/Center | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2014-04-15 |
| 1518383678 | Leelanau Urgent Care, PC | Family Medicine | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2014-03-13 |
| 1902113475 | Andrea L Knoke | Physician Assistant | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2010-09-07 |
| 1699924951 | John P Dunn | Internal Medicine | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2008-09-11 |
| 1326197179 | Leelanau Urgent Care, PC | Clinic/Center | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2007-01-10 |
| 1982773875 | Danette Lea Wells | Physician Assistant | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2006-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558913251 | Baybrooke Counseling | General Practice | 421 St. Josephs Ave, Suttons Bay, MI 49682 | 2019-07-12 |
| 1942756259 | Aleeah Bebermeyer | Physical Therapy Assistant | 73 W Fourth St., Sutton Bay, MI 49682 | 2016-08-28 |
| 1619346780 | Kathy Ann Bowers | Registered Nurse | 2300 N. Stallman Rd, Suttons Bay, MI 49682 | 2015-09-18 |
| 1508126517 | Grand Traverse Band of Ottawa and Chippewa Indians | Clinic/Center | 2300 N Stallman Road, Peshawbestown, MI 49682 | 2012-05-23 |
| 1063648491 | John Allen Nagel | Pharmacist | 321 N.st.joseph, Suttons Bay, MI 49682 | 2009-05-29 |
| 1205953395 | Mark Hall Hoffman | Chiropractor | 111 Madison St, Suttons Bay, MI 49682 | 2007-03-23 |
| 1104957109 | Lise C. Zahn | Physical Therapist | 73 Fourth St., Suttons Bay, MI 49682 | 2007-03-08 |
| 1457481251 | Andrea Darlene Xaver | Pharmacist | 321 N. St. Joseph St., Suttons Bay, MI 49682 | 2007-03-07 |
| 1871643858 | Steven David Hall | Dentist | 1299 Southwest Bay Shore Drive, Suttons Bay, MI 49682 | 2007-01-11 |
| 1457441362 | Donald R Mileski | Pharmacist | 321 N Saint Joseph St, Suttons Bay, MI 49682 | 2006-10-13 |
| Find all providers in zip 49682 | ||||
| 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 |
|---|---|---|---|---|
| 1699940791 | Suttons Bay Urgent Care Center | Family Medicine | 508 Saint Joseph Street, Suttons Bay, MI 49682-9800 | 2008-04-29 |
| 1730208810 | Jimmy Mistry | Family Medicine | 93 W Fourth St Ste B, Suttons Bay, MI 49682-8408 | 2007-03-28 |
| 1437228301 | Mark A Priest Do PC | Family Medicine | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2006-11-07 |
| 1588612972 | Phillip W Siemer | Family Medicine | 93 W Fourth St Ste C, Suttons Bay, MI 49682-8408 | 2006-05-05 |
| 1811952781 | Jessica M Paquette | Family Medicine | 718 N Saint Joseph St Unit K1, Suttons Bay, MI 49682-8422 | 2006-04-20 |
| 1518383678 | Leelanau Urgent Care, PC | Family Medicine | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2014-03-13 |
| 1558616144 | Geriatric Physician Staffing PC | Family Medicine | 124 W Fourth St, Suttons Bay, MI 49682-9733 | 2012-07-19 |
| 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 | ||||
| City | SUTTONS BAY |
| Zip Code | 49682 |
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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.