| Entity Name: | FRED S. MANN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Jun 1989 (36 years ago) |
| Document Number: | K93551 |
| FEI/EIN Number | 650126632 |
| Address: | 1313 SW 27TH AVE, MIAMI, FL, 33145, US |
| Mail Address: | 1313 SW 27TH AVE, MIAMI, FL, 33145, US |
| ZIP code: | 33145 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497086631 | 2010-01-28 | 2010-01-28 | 1313 SW 27TH AVE, MIAMI, FL, 331451252, US | 1313 SW 27TH AVE, MIAMI, FL, 331451252, US | |||||||||||||||||||||||||
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| Phone | +1 305-858-2228 |
| Fax | 3055413220 |
Authorized person
| Name | IVETTE CRUZ ROSENBERG |
| Role | ADMINISTRATOR |
| Phone | 3058582228 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME0051964 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 061433500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MANN, FRED S. | Agent | 1313 SW 27TH AVE, MIAMI, FL, 33145 |
| Name | Role | Address |
|---|---|---|
| MANN, FRED S. | President | 1313 SW 27TH AVE, MIAMI, FL, 33145 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-01-23 | No data | No data |
| REINSTATEMENT | 1995-10-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1995-08-25 | No data | No data |
| NAME CHANGE AMENDMENT | 1989-06-28 | FRED S. MANN, M.D., P.A. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
