| Entity Name: | CLINICAL GI AND HEPATOLOGY SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Feb 2017 (8 years ago) |
| Document Number: | L17000041753 |
| FEI/EIN Number | 82-0591051 |
| Address: | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837, US |
| Mail Address: | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837, US |
| ZIP code: | 32837 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972039345 | 2017-05-04 | 2021-12-01 | 1648 DERBY GLEN DR, ORLANDO, FL, 328378131, US | 1648 DERBY GLEN DR, ORLANDO, FL, 328378131, US | |||||||||||||||||||||||||
|
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| Phone | +1 407-760-4598 |
Authorized person
| Name | DR. MAHMUDUL HAQ |
| Role | OWNER |
| Phone | 4077604598 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 14LIJ |
| State | FL |
| Issuer | MEDICAID |
| Number | 109395700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HAQ MAHMUDUL | Agent | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837 |
| Name | Role | Address |
|---|---|---|
| HAQ MAHMUDUL | Authorized Member | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000120004 | OUR PERSONAL MD | EXPIRED | 2019-11-07 | 2024-12-31 | No data | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837 |
| G19000116878 | SURANJANA | EXPIRED | 2019-10-30 | 2024-12-31 | No data | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837--813 |
| G19000110542 | YOUR PERSONAL MD | EXPIRED | 2019-10-10 | 2024-12-31 | No data | 1648 DERBY GLEN DRIVE, ORLANDO, FL, 32837 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-19 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-05-08 |
| ANNUAL REPORT | 2019-03-18 |
| ANNUAL REPORT | 2018-04-19 |
| Florida Limited Liability | 2017-02-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
