Provider Demographics
NPI:1538982921
Name:VIRTUWELL TELEHEALTH LLC
Entity type:Organization
Organization Name:VIRTUWELL TELEHEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-715-8031
Mailing Address - Street 1:3209 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5917
Mailing Address - Country:US
Mailing Address - Phone:313-715-8031
Mailing Address - Fax:313-715-8031
Practice Address - Street 1:1021 E LINCOLNWAY # 5038
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4851
Practice Address - Country:US
Practice Address - Phone:313-715-8031
Practice Address - Fax:313-715-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty