Provider Demographics
NPI:1518050285
Name:CYPRESS FAMILY MEDICAL CENTER PA
Entity type:Organization
Organization Name:CYPRESS FAMILY MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTOKH
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:WALHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-454-0500
Mailing Address - Street 1:9371 CYPRESS LAKE DRIVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4945
Mailing Address - Country:US
Mailing Address - Phone:239-454-0500
Mailing Address - Fax:239-454-0663
Practice Address - Street 1:9371 CYPRESS LAKE DRIVE
Practice Address - Street 2:SUITE 16
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4945
Practice Address - Country:US
Practice Address - Phone:239-454-0500
Practice Address - Fax:239-454-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
42986OtherBCBS FL
FL118376200Medicaid
FL253868700Medicaid
F59607Medicare UPIN