| Entity Name: | MID-FLORIDA KIDNEY AND HYPERTENSION CARE, PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Dec 2005 (19 years ago) |
| Document Number: | L05000116469 |
| FEI/EIN Number | 331127721 |
| Mail Address: | 3113 TOFA CT, LONGWOOD, FL, 32779 |
| Address: | 631 PALM SPRINGS DR., 104, ALTAMONTE SPRINGS, FL, 32701 |
| ZIP code: | 32701 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326196908 | 2007-01-08 | 2024-10-29 | 631 PALM SPRINGS DR, STE 104, ALTAMONTE SPRINGS, FL, 327017854, US | 631 PALM SPRINGS DR, STE 104, ALTAMONTE SPRINGS, FL, 327017854, US | |||||||||||||||||||||||||||
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| Phone | +1 407-265-2540 |
| Fax | 4072659167 |
| Fax | 4072652540 |
Authorized person
| Name | DR. FUAD AFZAL |
| Role | DOCTOR |
| Phone | 4072652540 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME94056 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019377100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FUAD AFZAL M | Agent | 3113 TOFA CT, LONGWOOD, FL, 32779 |
| Name | Role | Address |
|---|---|---|
| AFZAL FUAD M | Manager | 3113 TOFA CT, LONGWOOD, FL, 32779 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-06 | 631 PALM SPRINGS DR., 104, ALTAMONTE SPRINGS, FL 32701 | No data |
| CHANGE OF MAILING ADDRESS | 2006-04-24 | 631 PALM SPRINGS DR., 104, ALTAMONTE SPRINGS, FL 32701 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-04-24 | FUAD, AFZAL MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-04-24 | 3113 TOFA CT, LONGWOOD, FL 32779 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-20 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-18 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-25 |
| ANNUAL REPORT | 2016-03-17 |
| ANNUAL REPORT | 2015-01-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
