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  5. KYLE M. CROFOOT, M.D., P.A.

KYLE M. CROFOOT, M.D., P.A.

Company Details

Entity Name: KYLE M. CROFOOT, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 01 Aug 1989 (36 years ago)
Document Number: L05848
FEI/EIN Number 59-2963264
Address: 1400 HILLCREST STREET, ORLANDO, FL 32803
Mail Address: 2205 Lakeside Drive, ORLANDO, FL 32803
ZIP code: 32803
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1679729271 2008-08-14 2008-08-14 1400 HILLCREST ST, ORLANDO, FL, 328034709, US 1400 HILLCREST ST, ORLANDO, FL, 328034709, US

Contacts
Phone +1 407-894-4330
Fax 4078944340

Authorized person
Name KYLE M. CROFOOT
Role OWNER
Phone 4078944330

Taxonomy
Taxonomy Code 261QM2500X - Medical Specialty Clinic/Center
License Number ME43757
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2015 592963264 2016-05-31 KYLE M. CROFOOT, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Signature of
Role Plan administrator
Date 2016-05-31
Name of individual signing KYLE M CROFOOT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-31
Name of individual signing KYLE M CROFOOT
Valid signature Filed with authorized/valid electronic signature
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2014 592963264 2015-07-21 KYLE M. CROFOOT, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Signature of
Role Plan administrator
Date 2015-07-21
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-21
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2013 592963264 2014-07-21 KYLE M. CROFOOT, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Signature of
Role Plan administrator
Date 2014-07-21
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-21
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2012 592963264 2013-07-18 KYLE M. CROFOOT, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Signature of
Role Plan administrator
Date 2013-07-18
Name of individual signing KYLE M. CROFOOT, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-18
Name of individual signing KYLE M. CROFOOT, M.D.
Valid signature Filed with authorized/valid electronic signature
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2011 592963264 2012-07-25 KYLE M. CROFOOT, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Plan administrator’s name and address
Administrator’s EIN 592963264
Plan administrator’s name KYLE M. CROFOOT, M.D., P.A.
Plan administrator’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803
Administrator’s telephone number 4078944330

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-25
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2010 592963264 2011-08-10 KYLE M. CROFOOT, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Plan administrator’s name and address
Administrator’s EIN 592963264
Plan administrator’s name KYLE M. CROFOOT, M.D., P.A.
Plan administrator’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803
Administrator’s telephone number 4078944330

Signature of
Role Plan administrator
Date 2011-08-10
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-08-10
Name of individual signing KYLE CROFOOT
Valid signature Filed with authorized/valid electronic signature
KYLE M. CROFOOT, M.D., P.A. 401(K) PROFIT SHARING PLAN 2009 592963264 2010-09-23 KYLE M. CROFOOT, M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 4078944330
Plan sponsor’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803

Plan administrator’s name and address
Administrator’s EIN 592963264
Plan administrator’s name KYLE M. CROFOOT, M.D., P.A.
Plan administrator’s address 1400 HILLCREST STREET, ORLANDO, FL, 32803
Administrator’s telephone number 4078944330

Signature of
Role Plan administrator
Date 2010-09-23
Name of individual signing KYLE M. CROFOOT, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-23
Name of individual signing KYLE M. CROFOOT, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CROFOOT, KYLE M., M.D. Agent 2205 Lakeside Drive, ORLANDO, FL 32803

Director

Name Role Address
crofoot, kyle m Director 2205 LAKESIDE DR., ORLANDO, FL 32803

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2017-04-26 1400 HILLCREST STREET, ORLANDO, FL 32803 No data
REGISTERED AGENT ADDRESS CHANGED 2017-04-26 2205 Lakeside Drive, ORLANDO, FL 32803 No data
CHANGE OF PRINCIPAL ADDRESS 2007-04-25 1400 HILLCREST STREET, ORLANDO, FL 32803 No data

Documents

Name Date
ANNUAL REPORT 2024-04-15
ANNUAL REPORT 2023-03-25
ANNUAL REPORT 2022-04-10
ANNUAL REPORT 2021-03-25
ANNUAL REPORT 2020-05-21
ANNUAL REPORT 2019-04-22
ANNUAL REPORT 2018-04-18
ANNUAL REPORT 2017-04-26
ANNUAL REPORT 2016-04-12
ANNUAL REPORT 2015-03-24

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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