| Entity Name: | MULTI-SPECIALTY & PRIMARY CARE PRACTICE GROUP OF LAKE WALES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 14 Aug 2008 (16 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: | L08000078208 |
| FEI/EIN Number | 26-3175940 |
| Address: | 1255 HIGHWAY 60 EAST, 100, LAKE WALES, FL 33853 |
| Mail Address: | 1255 HIGHWAY 60 EAST, 100, LAKE WALES, FL 33853 |
| ZIP code: | 33853 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467605634 | 2008-10-31 | 2009-04-08 | 1255 STATE ROAD 60 EAST, LAKE WALES, FL, 33853, US | 1255 STATE ROAD 60 EAST, LAKE WALES, FL, 33853, US | |||||||||||||||
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| Phone | +1 863-232-5111 |
| Fax | 8669220875 |
Authorized person
| Name | DR. KOLLAGUNTA S CHANDRASEKHAR |
| Role | OWNER |
| Phone | 8632945505 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PRESLEY, MICHAEL RESQ. | Agent | 10006 CROSS CREEK BLVD., 521, TAMPA, FL 33647 |
| Name | Role | Address |
|---|---|---|
| CHANDRASEKHAR, KOLLAGUNTA SMD | Managing Member | 1255 HIGHWAY 60, SUITE 100, LAKE WALES, FL 33853 |
| PASS, CAROLYN DMD | Managing Member | 1255 HIGHWAY 60, SUITE 100, LAKE WALES, FL 33853 |
| FAROUK, BELAL MD | Managing Member | 1255 HIGHWAY 60, SUITE 100, LAKE WALES, FL 33853 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-04-29 |
| ANNUAL REPORT | 2009-04-30 |
| Florida Limited Liability | 2008-08-14 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
