| Entity Name: | KENNETH HENSCHEL, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Nov 2017 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 29 Jul 2019 (6 years ago) |
| Document Number: | L17000243844 |
| FEI/EIN Number | 82-4114929 |
| Address: | 151 NW 11th Street, Suite W101, Homestead, FL, 33030, US |
| Mail Address: | 6530 SW 57th Place, South Miami, FL, 33143, US |
| ZIP code: | 33030 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003371378 | 2019-01-31 | 2019-03-06 | 10123 US HIGHWAY 441, LEESBURG, FL, 347883952, US | 10123 US HIGHWAY 441, LEESBURG, FL, 347883952, US | |||||||||||||||||||||
|
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| Phone | +1 352-426-5012 |
| Phone | +1 352-901-6288 |
Authorized person
| Name | MISS HELEN CHOI |
| Role | CREDENTIALING COORDINATOR |
| Phone | 3529016288 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012860100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HENSCHEL KENNETH A | Agent | 6530 SW 57th Place, South Miami, FL, 33143 |
| Name | Role | Address |
|---|---|---|
| HENSCHEL KENNETH A | Director | 6530 SW 57th Place, South Miami, FL, 33143 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-30 | 151 NW 11th Street, Suite W101, Homestead, FL 33030 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-30 | 151 NW 11th Street, Suite W101, Homestead, FL 33030 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-04-30 | 6530 SW 57th Place, South Miami, FL 33143 | No data |
| LC AMENDMENT | 2019-07-29 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-01-11 | HENSCHEL, KENNETH A | No data |
| REINSTATEMENT | 2019-01-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-09 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-03-05 |
| ANNUAL REPORT | 2020-04-30 |
| LC Amendment | 2019-07-29 |
| REINSTATEMENT | 2019-01-11 |
| Florida Limited Liability | 2017-11-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
