| Entity Name: | IMAD TAHBUB MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Nov 2017 (7 years ago) |
| Document Number: | L17000231115 |
| FEI/EIN Number | 82-4083109 |
| Address: | 190 INDEPENDENCE LN, MAITLAND, FL, 32751, US |
| Mail Address: | 190 INDEPENDENCE LN, MAITLAND, FL, 32751, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679054993 | 2018-08-24 | 2021-07-07 | 5728 MAJOR BLVD STE 528, ORLANDO, FL, 328197962, US | 1726 MARKHAM GLEN CIR, LONGWOOD, FL, 327792797, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 914-233-4678 |
Authorized person
| Name | FAIZA FAISAL |
| Role | OFFICE MANAGER |
| Phone | 4075456232 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1679054993 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TAHBUB IMAD | Agent | 190 INDEPENDENCE LN, MAITLAND, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| TAHBUB IMAD | Manager | 190 INDEPENDENCE LN, MAITLAND, FL, 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-30 | 190 INDEPENDENCE LN, UNIT 216, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 190 INDEPENDENCE LN, UNIT 216, MAITLAND, FL 32751 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-30 | 190 INDEPENDENCE LN, UNIT 216, MAITLAND, FL 32751 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-06-05 |
| AMENDED ANNUAL REPORT | 2019-10-30 |
| ANNUAL REPORT | 2019-05-15 |
| ANNUAL REPORT | 2018-04-23 |
| Florida Limited Liability | 2017-11-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
