Crystal Lake Clinic Pc

NPI 1134491731 - Family Medicine - 207Q00000X

NPI Details
NPI 1134491731
Enumeration Date 01/30/2012
Last Updated 01/30/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name RICHARD RICHARD
Position PRESIDENT
Phone (231) 882-9661
Fax
Practice Location
1806 E PARKDALE AVE STE 2
MANISTEE MI, 49660-9364, US
Phone (231) 882-9661
Fax
Business Location
6227 FRANKFORT HWY
BENZONIA MI, 49616-8632, US
Phone (231) 882-9661
Fax (231) 882-9616
Toxanomy
Taxonomy Code 207Q00000X
License State
License Number
Remove 1134491731 NPI Number
 

According to our database, Crystal Lake Clinic Pc NPI is 1134491731, taxonomy code is 207Q00000X Crystal Lake Clinic Pc physically located at 1806 E Parkdale Ave Ste 2, Manistee MI, 49660-9364. NPI Number 1033115704 has the healthcare provider type.

Sponsored links

1134491731 NPI number is provided on an as is basis without warranty of any kind. 1134491731 is maintained by the National Plan & Provider Enumeration System. The contents of Crystal Lake Clinic Pc are for informational purposes only.