| Entity Name: | FLORIDA KIDNEY PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 May 2016 (9 years ago) |
| Document Number: | L16000091138 |
| FEI/EIN Number | 81-2861365 |
| Address: | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637, US |
| Mail Address: | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637, US |
| ZIP code: | 33637 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548930068 | 2021-09-16 | 2021-09-16 | 450 MALABAR RD SE UNIT 102, PALM BAY, FL, 329073111, US | 450 MALABAR RD SE UNIT 102, PALM BAY, FL, 329073111, US | |||||||||||||||
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| Phone | +1 321-768-3655 |
| Fax | 3218313024 |
Authorized person
| Name | ANDRES JULIAN ARANDA |
| Role | CREDENTIALING SPECIALIST |
| Phone | 4806106158 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Thompson Leslie D | Agent | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637 |
| Name | Role | Address |
|---|---|---|
| UTTAMCHANDANI SHYAM | Manager | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637 |
| Name | Role | Address |
|---|---|---|
| BALIGA RAJ | Authorized Member | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637 |
| Gadh Rajdeep | Authorized Member | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637 |
| Casaretto Alberto | Authorized Member | 407 SE 9th Street, Ft.Lauderdale, FL, 33316 |
| Patel Vishnu | Authorized Member | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637 |
| Name | Role | Address |
|---|---|---|
| Thompson Leslie D | Prac | 12662 TELECOM DR., TEMPLE TERRACE, FL, 33637 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000135427 | FLORIDA VASCULAR CENTER | ACTIVE | 2023-11-03 | 2028-12-31 | No data | 12662 TELECOM DRIVE, TEMPLE TERRACE, FL, 33637 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2018-04-24 | Thompson, Leslie D | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-02-13 |
| Florida Limited Liability | 2016-05-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
