| Entity Name: | MANDAL'S CONSERVATIVE NEPHROLOGY PRACTICE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Mar 2016 (9 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L16000048319 |
| Address: | 800 ZEAGLER DR, SUITE 510, PALATKA, FL, 32177, US |
| Mail Address: | 800 ZEAGLER DR, SUITE 510, PALATKA, FL, 32177, US |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376904417 | 2016-03-17 | 2016-03-17 | 800 ZEAGLER DR, PALATKA, FL, 321773883, US | 800 ZEAGLER DR, PALATKA, FL, 321773883, US | |||||||||||||||||||||||
|
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| Phone | +1 904-824-8158 |
Authorized person
| Name | DR. ANIL KUMAR MANDAL |
| Role | OWNER |
| Phone | 9043051234 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| License Number | ME0074439 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 255413500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MANDAL ANIL K | Agent | 92 LITKE LANE, ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| MANDAL ANIL K | Manager | 92 LITKE LANE, ST AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2016-03-08 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
