Provider Demographics
NPI:1528606241
Name:CYPRESS CARDIOLOGY PA
Entity Type:Organization
Organization Name:CYPRESS CARDIOLOGY PA
Other - Org Name:CYPRESS CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAROUK
Authorized Official - Middle Name:
Authorized Official - Last Name:BELAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-899-6735
Mailing Address - Street 1:1286 S LINDEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3457
Mailing Address - Country:US
Mailing Address - Phone:810-285-9996
Mailing Address - Fax:810-820-3443
Practice Address - Street 1:1286 S LINDEN RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3457
Practice Address - Country:US
Practice Address - Phone:810-285-9996
Practice Address - Fax:810-820-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN36490056Medicaid