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General NPI Number Information
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NPI Number | 1699048546
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Entity Type | Organization
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Legal Business Name | CYPRESS CREEK MEDICAL CENTER,INC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 912 NE 62ND ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-4110
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Country | US
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Telephone | 954-771-3113
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Fax | 954-771-2856
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Provider Business Mailing Address
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Address Line | 912 NE 62ND ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-4110
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Country | US
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Telephone | 954-771-3113
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Fax | 954-771-2856
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AVTAR SANDHU
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Credential | M.D
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Telephone | 954-771-3113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0041535
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License Number State | FL
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