| Entity Name: | MANUS PRASERTHDAM, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 01 May 1980 (45 years ago) |
| Date of dissolution: | 02 Nov 2015 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Nov 2015 (9 years ago) |
| Document Number: | 669372 |
| FEI/EIN Number | 59-1994620 |
| Address: | 13774 Tern Lane, Clearwater, FL 33762 |
| Mail Address: | 13774 Tern Lane, Clearwater, FL 33762 |
| ZIP code: | 33762 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376770826 | 2009-06-11 | 2009-06-11 | 1201 5TH AVE N STE 208, ST PETERSBURG, FL, 337051410, US | 1201 5TH AVE N STE 208, ST PETERSBURG, FL, 337051410, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-894-1122 |
| Fax | 7278940033 |
Authorized person
| Name | DR. MANUS PRASERTHDAM |
| Role | OWNER |
| Phone | 7278941122 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 0666950 |
| State | FL |
| Issuer | MEDICAID |
| Number | 62149 |
| State | FL |
| Issuer | CIGNA |
| Number | 0184828 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 212769 |
| State | FL |
| Issuer | UNITED HEALTHCARE |
| Number | 3106012 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PRASERTHDAM, MANUS M.D. | Agent | 13774 Tern Lane, Clearwater, FL 33762 |
| Name | Role | Address |
|---|---|---|
| PRASERTHDAM, MANUS MD | President | 13774 Tern Lane, Clearwater, FL 33762 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-11-02 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-08 | 13774 Tern Lane, Clearwater, FL 33762 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-08 | 13774 Tern Lane, Clearwater, FL 33762 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-08 | 13774 Tern Lane, Clearwater, FL 33762 | No data |
| REGISTERED AGENT NAME CHANGED | 1996-05-01 | PRASERTHDAM, MANUS M.D. | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2015-11-02 |
| ANNUAL REPORT | 2015-01-03 |
| ANNUAL REPORT | 2014-01-08 |
| ANNUAL REPORT | 2013-01-10 |
| ANNUAL REPORT | 2012-02-01 |
| ANNUAL REPORT | 2011-01-05 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-01-07 |
| ANNUAL REPORT | 2008-01-07 |
| ANNUAL REPORT | 2007-01-17 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
