| Entity Name: | KASRAEIAN UROLOGY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Sep 2008 (16 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Sep 2010 (14 years ago) |
| Document Number: | L08000091032 |
| FEI/EIN Number | 943443898 |
| Address: | 6269 BEACH BLVD, SUITE 2, JACKSONVILLE, FL, 32216 |
| Mail Address: | 6269 BEACH BLVD, SUITE 2, JACKSONVILLE, FL, 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578727442 | 2008-07-10 | 2008-10-03 | 6269 BEACH BLVD, SUITE 2, JACKSONVILLE, FL, 322162768, US | 6269 BEACH BLVD, SUITE 2, JACKSONVILLE, FL, 322162768, US | |||||||||||||||||||||
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| Phone | +1 904-727-7955 |
| Fax | 9047277976 |
Authorized person
| Name | DR. AHMAD KASRAEIAN |
| Role | PRESIDENT |
| Phone | 9047277955 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA GROUP |
| Number | 39658 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Chamberlain Joel CPA | Agent | 4350 Pablo Professional Ct, Jacksonville, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| KASRAEIAN AHMAD D | Manager | 6269 BEACH BLVD, JACKSONVILLE, FL, 32216 |
| KASRAEIAN ALI D | Manager | 6269 BEACH BLVD, JACKSONVILLE, FL, 32216 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000006099 | KASRAEIAN UROLOGY DIVISION OF ICON | EXPIRED | 2011-01-13 | 2016-12-31 | No data | 6269 BEACH BLVD., SUITE 2, JACKSONVILLE, FL, 32226 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-02-08 | Chamberlain, Joel, CPA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-08 | 4350 Pablo Professional Ct, Jacksonville, FL 32224 | No data |
| REINSTATEMENT | 2010-09-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2009-10-20 | KASRAEIAN UROLOGY, PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-03-24 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
