Provider Demographics
NPI:1780351049
Name:VIRTUO PROFESSIONAL GROUP LLC
Entity type:Organization
Organization Name:VIRTUO PROFESSIONAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:KAREEM
Authorized Official - Last Name:QADEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-800-1682
Mailing Address - Street 1:50740 PRINCESS WAY STE 700
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4339
Mailing Address - Country:US
Mailing Address - Phone:574-800-1682
Mailing Address - Fax:
Practice Address - Street 1:50740 PRINCESS WAY STE 700
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4339
Practice Address - Country:US
Practice Address - Phone:800-410-3047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty