Provider Demographics
NPI:1205437159
Name:VIRTUAL PHYSICIAN SERVICES CORP
Entity type:Organization
Organization Name:VIRTUAL PHYSICIAN SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-671-7119
Mailing Address - Street 1:11373 CORTEZ BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5406
Mailing Address - Country:US
Mailing Address - Phone:989-671-7119
Mailing Address - Fax:
Practice Address - Street 1:11373 CORTEZ BLVD STE 401
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5406
Practice Address - Country:US
Practice Address - Phone:989-671-7119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty