| Entity Name: | PHYSICAL MEDICINE GROUP, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Apr 2001 (24 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L01000006044 |
| FEI/EIN Number | 593710858 |
| Address: | 509 W. COLONIAL DR., ORLANDO, FL, 32804 |
| Mail Address: | 509 W. COLONIAL DR., ORLANDO, FL, 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902004732 | 2007-07-03 | 2018-06-21 | 1339 W COLONIAL DR, ORLANDO, FL, 32804, US | 1339 W COLONIAL DR, ORLANDO, FL, 32804, US | |||||||||||||||||||||||||
|
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| Phone | +1 407-420-2199 |
| Fax | 4074204599 |
Authorized person
| Name | DR. MLADEN ANTOLIC |
| Role | MEDICAL DIRECTOR |
| Phone | 4074202199 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME 49756 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBSFL |
| Number | 77164 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ANTOLIC MLADEN M | Agent | 509 W. COLONIAL DR, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| ANTOLIC MLADEN | Director | 509 W. COLONIAL DR, ORLANDO, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2008-10-03 | 509 W. COLONIAL DR., ORLANDO, FL 32804 | No data |
| REINSTATEMENT | 2008-10-03 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-10-03 | 509 W. COLONIAL DR, ORLANDO, FL 32804 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-10-03 | ANTOLIC, MLADEN MD | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-10-03 | 509 W. COLONIAL DR., ORLANDO, FL 32804 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2006-01-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000224975 | LAPSED | 1000000253704 | OSCEOLA | 2012-02-29 | 2022-03-28 | $ 1,319.61 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MAITLAND SERVICE CENTER, 2301 MAITLAND CENTER PKWY STE 160, MAITLAND FL327514192 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-03-18 |
| ANNUAL REPORT | 2009-06-22 |
| REINSTATEMENT | 2008-10-03 |
| ANNUAL REPORT | 2007-01-08 |
| REINSTATEMENT | 2006-01-17 |
| ANNUAL REPORT | 2004-04-28 |
| ANNUAL REPORT | 2003-08-05 |
| ANNUAL REPORT | 2002-02-26 |
| Florida Limited Liabilites | 2001-04-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
