CRYSTAL LAKE CLINIC P.C. (NPI# 1386028769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386028769 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE CLINIC P.C. |
| Practice Address |
6170 Us Highway 31 N Williamsburg MI 49690-9306 |
| Mailing Address |
6227 Frankfort Hwy Benzonia MI 49616-8632 |
| Practice Telephone | 2317153614 |
| Mailing Telephone | 2318829661 |
| Mailing Fax Number | 2318829616 |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2015-07-15 |
| 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 |
|---|---|---|---|---|
| 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 |
| 1164945978 | Crystal Lake Clinic P.C. | Family Medicine | 650 S West Bay Shore Dr, Suttons Bay, MI 49682-9587 | 2017-07-24 |
| 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 |
6170 US HIGHWAY 31 N |
| City | WILLIAMSBURG |
| State | MI |
| Zip Code | 49690-9306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174020739 | Cody Robert Zietz | Occupational Therapist | 6170 Us Highway 31 N, Williamsburg, MI 49690-8306 | 2018-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912563479 | Trista Rosing | Student in an Organized Health Care Education/Training Program | 5423 Williamsburg Rd, Williamsburg, MI 49690 | 2019-05-10 |
| 1265802482 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 490 East M-72, Williamsburg, MI 49690 | 2015-09-30 |
| 1861891202 | Erica Jayne Beia Barker | Speech-Language Pathologist | 6501 U.S. 31 North, Williamsburg, MI 49690 | 2014-08-21 |
| 1740478601 | David May Do Pllc | Family Medicine | 3939 M-72 East #210, Williamsburg, MI 49690 | 2007-10-04 |
| 1033324546 | Antrim County Commission On Aging | Home Health | 10519 W. Us 31, Williamsburg, MI 49690 | 2007-05-10 |
| 1740337393 | Dewey Carl Benson | Family Medicine | 3877 E M72, Williamsburg, MI 49690 | 2007-01-05 |
| 1124107115 | Whitewater Township | Ambulance | 8380 Old M-72, Williamsburg, MI 49690 | 2006-11-02 |
| 1871682922 | Ruthann O'brien | Occupational Therapist | 5793 M-72 Nw, Williamsburg, MI 49690 | 2006-10-12 |
| 1538263231 | Base of The Bays Dermatology PC | Dermatology | 3950 Shore Rd, Williamsburg, MI 49690 | 2006-09-12 |
| 1972560308 | Cara C Gruber | Physical Therapist | 4480 Mt Hope Rd, Ste A, Williamsburg, MI 49690 | 2006-04-28 |
| Find all providers in zip 49690 | ||||
| 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 |
|---|---|---|---|---|
| 1487138020 | Kenneth Allen Kleyn | Family Medicine | 5548 Millbrook Dr, Williamsburg, MI 49690-9214 | 2018-09-19 |
| 1487188579 | Christina A. Mutch | Family Medicine | 2225 S Henry St Ste U2, Williamsburg, VA 23185-3973 | 2017-04-14 |
| 1669835989 | Community Health Systems Inc. | Family Medicine | 8965 Shoestring Trail, Williamsburg, WV 24991-0010 | 2016-04-04 |
| 1043606098 | Sentara Medical Group | Family Medicine | 1915 Pocahontas Trl, Ste F5, Williamsburg, VA 23185-5663 | 2015-04-07 |
| 1548681216 | Marengo Memorial Hospital | Family Medicine | 498 N Highland St., Williamsburg, IA 52361-9695 | 2013-12-26 |
| 1265616221 | First Med of Williamsburg | Family Medicine | 312 Second Street, Williamsburg, VA 23185 | 2007-12-26 |
| 1740478601 | David May Do Pllc | Family Medicine | 3939 M-72 East #210, Williamsburg, MI 49690 | 2007-10-04 |
| 1588865026 | Deanna Lynne Trail | Family Medicine | 3096 Nathaniels Grn, Williamsburg, VA 23185-7505 | 2007-05-31 |
| 1801934682 | Giacomo A Ricciarelli | Family Medicine | 263 Mclaws Circle, Suite 105, Williamsburg, VA 23185-5629 | 2007-02-02 |
| 1366530586 | Thomas Doncaster | Family Medicine | 475 N Highway 25 W, Suite 100, Williamsburg, KY 40769-1576 | 2006-10-11 |
| Find all providers in WILLIAMSBURG | ||||
| City | WILLIAMSBURG |
| Zip Code | 49690 |
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.