| Entity Name: | SHIELD MEDICAL GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jul 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 11 Oct 2018 (6 years ago) |
| Document Number: | L17000153137 |
| FEI/EIN Number | 82-2212398 |
| Address: | 110 WYNDHAM DR, WINTER HAVEN, FL, 33884, US |
| Mail Address: | PO BOX 919558, ORLANDO, FL, 32891, US |
| ZIP code: | 33884 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184125338 | 2018-02-23 | 2022-04-06 | PO BOX 919558, ORLANDO, FL, 328919558, US | 4597 CASABLANCA CIR, SEBRING, FL, 338701206, US | |||||||||||||||||||||||||||
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| Phone | +1 863-236-9550 |
| Fax | 8632369551 |
| Fax | 8778323363 |
Authorized person
| Name | DR. KULMEET S KUNDLAS |
| Role | PRESIDENT |
| Phone | 8632559595 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME73743 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 252638700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KUNDLAS KULMEET | Agent | 110 WYNDHAM DR, WINTER HAVEN, FL, 33884 |
| Name | Role | Address |
|---|---|---|
| KUNDLAS KULMEET | Authorized Member | 110 WYNDHAM DR, WINTER HAVEN, FL, 33884 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-07-17 | 110 WYNDHAM DR, WINTER HAVEN, FL 33884 | No data |
| REINSTATEMENT | 2018-10-11 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-11 | KUNDLAS, KULMEET | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| LC NAME CHANGE | 2017-10-03 | SHIELD MEDICAL GROUP, PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-24 |
| AMENDED ANNUAL REPORT | 2023-07-17 |
| ANNUAL REPORT | 2023-02-12 |
| ANNUAL REPORT | 2022-06-16 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-03-26 |
| ANNUAL REPORT | 2019-04-28 |
| REINSTATEMENT | 2018-10-11 |
| LC Name Change | 2017-10-03 |
| Florida Limited Liability | 2017-07-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
