Healthcare Provider Details

I. General information

NPI: 1669302394
Provider Name (Legal Business Name): VIRTUMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WILLARD ST STE B
COCOA FL
32922-8001
US

IV. Provider business mailing address

455 N CITYFRONT PLAZA DR STE 2515
CHICAGO IL
60611-5323
US

V. Phone/Fax

Practice location:
  • Phone: 708-628-2326
  • Fax: 630-566-8294
Mailing address:
  • Phone: 708-628-2326
  • Fax: 630-566-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RIZWAN KHAN
Title or Position: OWNER
Credential:
Phone: 708-628-2326