| Entity Name: | LAKE MEDICAL GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jan 2011 (14 years ago) |
| Document Number: | L11000000279 |
| FEI/EIN Number | 274429325 |
| Address: | 14750 NW 77TH CT, SUITE # 304, MIAMI LAKES, FL, 33016, US |
| Mail Address: | 14750 NW 77TH CT, SUITE # 304, MIAMI LAKES, FL, 33016, US |
| ZIP code: | 33016 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215767496 | 2024-08-03 | 2024-08-03 | 14750 NW 77TH CT STE 304, MIAMI LAKES, FL, 330161537, US | 14750 NW 77TH CT STE 304, MIAMI LAKES, FL, 330161537, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-507-4400 |
| Fax | 3058262840 |
Authorized person
| Name | ALFONSO GONZALEZ |
| Role | PRESIDENT |
| Phone | 3055074400 |
Taxonomy
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QI0500X - Infusion Therapy Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Is Primary | No |
| Taxonomy Code | 261QX0100X - Occupational Medicine Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 335V00000X - Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Is Primary | No |
| Name | Role |
|---|---|
| RELIABLE ACCOUNTING & TAX SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| GONZALEZ ALFONSO | Manager | 14750 NW 77th CT, MIAMI LAKES, FL, 33016 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-10 | 14750 NW 77TH CT, SUITE # 304, MIAMI LAKES, FL 33016 | No data |
| CHANGE OF MAILING ADDRESS | 2023-07-10 | 14750 NW 77TH CT, SUITE # 304, MIAMI LAKES, FL 33016 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| AMENDED ANNUAL REPORT | 2023-07-10 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-07 |
| ANNUAL REPORT | 2020-04-29 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-04-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
