CRYSTAL LAKE CLINIC P.C.
NPI 1679957617
Family Medicine in Traverse City, MI

Q: What is Crystal Lake Clinic P.C.'s NPI number?

The NPI number for Crystal Lake Clinic P.C. is 1679957617. It was assigned to this organization in the NPPES registry on July 18, 2015.

Q: What is Crystal Lake Clinic P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since July 18, 2015

1225 W FRONT ST, SUITE C, TRAVERSE CITY, MI 49684(231) 715-3601 Get Directions Write a Review

NPPES record last updated: July 18, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Crystal Lake Clinic P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRYSTAL LAKE CLINIC P.C. (NPI 1679957617) is a healthcare organization registered as a family medicine in Traverse City, Michigan and active in the NPI registry since July 2015. The organization lists Richard C Nielsen, President, as its authorized official.

NPPES Registry Identity

NPI1679957617

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameCRYSTAL LAKE CLINIC P.C.

Location Address1225 W FRONT ST, SUITE CTraverse City, MI 49684-2368

Mailing Address6227 Frankfort HwyBenzonia, MI 49616-8632 · (231) 882-9661 · Fax (231) 882-9616

Phone(231) 715-3601

Organization SubpartNo

Authorized OfficialRichard C NielsenPresident · (231) 882-9661

Enumeration DateJuly 18, 2015

✔ NPI 1679957617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

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.

1225 W FRONT ST, Traverse City, MI 49684

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Other Identifiers 1

Medicare PIN0N38430MI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER NICOLE DRAKE PT

Physical Therapist