| Entity Name: | MIDTOWN MIAMI MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 09 Jul 2010 (15 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: | L10000072297 |
| Address: | 3800 N MAIM AVENUE, MIAMI, FL, 33127 |
| Mail Address: | 3800 N MAIM AVENUE, MIAMI, FL, 33127 |
| ZIP code: | 33127 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164739553 | 2010-09-07 | 2010-09-07 | 3800 N MIAMI AVE, MIAMI, FL, 331272906, US | 3800 N MIAMI AVE, MIAMI, FL, 331272906, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-603-8990 |
| Fax | 3056038970 |
Authorized person
| Name | WILLIAM RYAN WALKER |
| Role | PRESIDENT |
| Phone | 3056038990 |
Taxonomy
| Taxonomy Code | 111NI0013X - Independent Medical Examiner Chiropractor |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QP3300X - Pain Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| WALKER WILLIAM R | Agent | 550 MICHIGAN AVENUE, MIAMI BEACH, FL, 33139 |
| Name | Role | Address |
|---|---|---|
| JAFFE DOUG T | Managing Member | 19403 SABLE LAKE DR., BOCA RATON, FL, 33434 |
| ROYAL OAK TRUST | Managing Member | 19403 SABLE LAKE DR., BOCA RATON, FL, 33434 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| LC AMENDMENT | 2011-09-19 | No data | No data |
| LC AMENDMENT | 2010-08-27 | No data | No data |
| Name | Date |
|---|---|
| LC Amendment | 2011-09-19 |
| LC Amendment | 2010-08-27 |
| Florida Limited Liability | 2010-07-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
