| Entity Name: | GEORGE R. IKELER M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Mar 1973 (52 years ago) |
| Document Number: | 604232 |
| FEI/EIN Number | 591450812 |
| Address: | 31450 CHURCH STREET, SORRENTO, FL, 32776 |
| Mail Address: | 31450 CHURCH STREET, SORRENTO, FL, 32776 |
| ZIP code: | 32776 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508097759 | 2009-08-06 | 2013-02-05 | 31450 CHURCH ST, SORRENTO, FL, 327769594, US | 31450 CHURCH ST, SORRENTO, FL, 327769594, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-735-4044 |
| Fax | 3527352536 |
Authorized person
| Name | DR. GEORGE RAYMOND IKELER |
| Role | PRESIDENT |
| Phone | 3527354044 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME12314 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 043349700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| IKELER, GEORGE R., M.D. | Agent | 31450 CHURCH STREET, SORRENTO, FL, 32776 |
| Name | Role | Address |
|---|---|---|
| IKELER, GEORGE R., M.D. | President | 31450 CHURCH STREET, SORRENTO, FL, 32776 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
