| Entity Name: | LAKE ENDOCRINOLOGY AND DIABETES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Feb 2017 (8 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 14 Apr 2023 (2 years ago) |
| Document Number: | L17000041131 |
| FEI/EIN Number | 82-0630014 |
| Address: | 13123 66th Street, Largo, FL, 33773, US |
| Mail Address: | 13123 66th Street, Largo, FL, 33773, US |
| ZIP code: | 33773 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619418563 | 2017-03-12 | 2021-05-02 | 13123 66TH ST, LARGO, FL, 337731812, US | 13123 66TH ST, LARGO, FL, 337731812, US | |||||||||||||||||||||||
|
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| Phone | +1 727-477-1039 |
| Fax | 7274770498 |
Authorized person
| Name | BRIAN MATTHEW LAKE |
| Role | AMBR |
| Phone | 7274771039 |
Taxonomy
| Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | OS9591 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Lake Brian M | Agent | 13123 66th Street, Largo, FL, 33773 |
| Name | Role | Address |
|---|---|---|
| LAKE BRIAN M | Authorized Member | 13123 66th Street, Largo, FL, 33773 |
| LAKE JEANIE | Authorized Member | 13123 66th Street, Largo, FL, 33773 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2023-04-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-04 | 13123 66th Street, Largo, FL 33773 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-04 | 13123 66th Street, Largo, FL 33773 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-04 | 13123 66th Street, Largo, FL 33773 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-08-19 | Lake, Brian Matthew | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| LC Amendment | 2023-04-14 |
| ANNUAL REPORT | 2023-03-04 |
| AMENDED ANNUAL REPORT | 2022-08-19 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-02-15 |
| ANNUAL REPORT | 2019-02-15 |
| ANNUAL REPORT | 2018-01-17 |
| Florida Limited Liability | 2017-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
