Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Crystal Lake Clinic PC

Organization Family Medicine Physician · NPI 1053780072

Crystal Lake Clinic PC is a Family Medicine Physician in Elk Rapids, Michigan. Registered with an NPI since 2015.

In the registry since
2015
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

124 Ames St
Elk Rapids, MI 49629-9449
Phone: (231) 264-8282
Fax: (231) 264-6655
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1053780072
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Richard Nielsen — President · (231) 882-9661
NPI enumeratedSeptember 21, 2015
Last updated in NPPESSeptember 21, 2015
Mailing address6227 Frankfort Hwy, Benzonia, MI 49616-8632

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