| Entity Name: | ACADEMIC & CLINICAL INFECTIOUS DISEASES PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Dec 1974 (50 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 23 Sep 2013 (11 years ago) |
| Document Number: | 467900 |
| FEI/EIN Number | 59-1568228 |
| Address: | 4308 ALTON RD., SUITE 860, MIAMI BEACH, FL 33140 |
| Mail Address: | 4308 ALTON RD., SUITE 860, MIAMI BEACH, FL 33140 |
| ZIP code: | 33140 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811926611 | 2006-07-02 | 2014-05-13 | 4300 ALTON RD, GREENE PAVILION #450, MIAMI BEACH, FL, 331402800, US | 4300 ALTON RD, GREENE PAVILION #450, MIAMI BEACH, FL, 331402800, US | |||||||||||||||||||||||||
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| Phone | +1 305-673-5490 |
| Fax | 3056742765 |
Authorized person
| Name | DR. JOSEPH C CHAN |
| Role | PRESIDENT |
| Phone | 3056735490 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 0455154 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 374195800 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ACADEMIC & CLINICAL INFECTIOUS DISEASES PROFIT SHARING PLAN | 2021 | 591568228 | 2022-09-21 | ACADEMIC & CLINICAL INFECTIOUS DISEASES PA | 4 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-09-21 |
| Name of individual signing | CYNTHIA RIVERA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3056742766 |
| Plan sponsor’s address | 4308 ALTON RD SUITE 860, MIAMI BEACH, FL, 33140 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-04 |
| Name of individual signing | CYNTHIA RIVERA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| TUDA, CLAUDIO D, MD | Agent | 4308 ALTON ROAD, SUITE 860, MIAMI BEACH, FL 33140 |
| Name | Role | Address |
|---|---|---|
| Tuda, Claudio D, MD | President | 4308 Alton Rd, Suite 860 Miami Beach, FL 33140 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000047870 | ACID | ACTIVE | 2024-04-09 | 2029-12-31 | No data | 4308 ALTON RD, SUITE 860, MIAMI BEACH, FL, 33140 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-02 | TUDA, CLAUDIO D, MD | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-23 | 4308 ALTON RD., SUITE 860, MIAMI BEACH, FL 33140 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-23 | 4308 ALTON RD., SUITE 860, MIAMI BEACH, FL 33140 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-23 | 4308 ALTON ROAD, SUITE 860, MIAMI BEACH, FL 33140 | No data |
| NAME CHANGE AMENDMENT | 2013-09-23 | ACADEMIC & CLINICAL INFECTIOUS DISEASES PA | No data |
| NAME CHANGE AMENDMENT | 1995-12-14 | RATZAN AND CHAN, M.D., P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-03-11 |
| ANNUAL REPORT | 2020-03-23 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-01-24 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 06 Feb 2025
Sources: Florida Department of State
