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  5. KALPANA GORTHI, MD, PLLC

KALPANA GORTHI, MD, PLLC

Company Details

Entity Name: KALPANA GORTHI, MD, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 29 Jan 2018 (7 years ago)
Document Number: L18000025832
FEI/EIN Number 82-4261420
Address: 3155 SUNTREE BLVD, ROCKLEDGE, FL, 32955, US
Mail Address: 3155 SUNTREE BLVD, ROCKLEDGE, FL, 32955, US
ZIP code: 32955
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1134616220 2018-04-16 2022-02-10 3155 SUNTREE BLVD STE 102, ROCKLEDGE, FL, 329555720, US 3155 SUNTREE BLVD STE 102, ROCKLEDGE, FL, 329555720, US

Contacts
Phone +1 321-425-3187
Fax 3214253188

Authorized person
Name KALPANA GORTHI
Role OWNER/ PHYSICIAN
Phone 9315757833

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KALPANA GORTHI, MD, PLLC 401(K) PROFIT SHARING PLAN 2023 824261420 2024-07-16 KALPANA GORTHI, MD, PLLC 3
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3214253187
Plan sponsor’s address 6450 N WICKHAM ROAD, SUITE 106, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2024-07-15
Name of individual signing KALPANA GORTHI
Valid signature Filed with authorized/valid electronic signature
KALPANA GORTHI, MD, PLLC 401(K) PROFIT SHARING PLAN 2023 824261420 2024-08-01 KALPANA GORTHI, MD, PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3214253187
Plan sponsor’s address 3155 , SUNTREE BLVD, STE 102, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2024-08-01
Name of individual signing KALPANA GORTHI
Valid signature Filed with authorized/valid electronic signature
KALPANA GORTHI, MD, PLLC 401(K) PROFIT SHARING PLAN 2022 824261420 2023-09-01 KALPANA GORTHI, MD, PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3214253187
Plan sponsor’s address 6450 N WICKHAM ROAD, SUITE 106, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2023-09-01
Name of individual signing KALPANA GORTHI
Valid signature Filed with authorized/valid electronic signature
KALPANA GORTHI, MD, PLLC 401(K) PROFIT SHARING PLAN 2021 824261420 2022-08-29 KALPANA GORTHI, MD, PLLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3214253187
Plan sponsor’s address 6450 N WICKHAM ROAD, SUITE 106, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2022-08-29
Name of individual signing KALPANA GORTHI
Valid signature Filed with authorized/valid electronic signature
KALPANA GORTHI, MD, PLLC 401(K) PROFIT SHARING PLAN 2020 824261420 2021-09-29 KALPANA GORTHI, MD, PLLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3214253187
Plan sponsor’s address 6450 N WICKHAM ROAD, SUITE 106, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2021-09-29
Name of individual signing KALPANA GORTHI
Valid signature Filed with authorized/valid electronic signature
KALPANA GORTHI, MD, PLLC 401(K) PROFIT SHARING PLAN 2019 824261420 2020-06-24 KALPANA GORTHI, MD, PLLC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3214253187
Plan sponsor’s address 6450 N WICKHAM ROAD, SUITE 106, MELBOURNE, FL, 32940

Signature of
Role Plan administrator
Date 2020-06-24
Name of individual signing KALPANA GORTHI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Gorthi Kalpana Agent 3155 SUNTREE BLVD, ROCKLEDGE, FL, 32955

Auth

Name Role Address
GORTHI KALPANA Auth 2942 BELLWIND CIRCLE, ROCKLEDGE, FL, 32955
Amit Sharma Auth 2942 BELLWIND CIRCLE, ROCKLEDGE, FL, 32955

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2022-03-08 3155 SUNTREE BLVD, STE 102, ROCKLEDGE, FL 32955 No data
CHANGE OF PRINCIPAL ADDRESS 2022-01-26 3155 SUNTREE BLVD, STE 102, ROCKLEDGE, FL 32955 No data
CHANGE OF MAILING ADDRESS 2022-01-26 3155 SUNTREE BLVD, STE 102, ROCKLEDGE, FL 32955 No data
REGISTERED AGENT NAME CHANGED 2020-03-16 Gorthi, Kalpana No data

Documents

Name Date
ANNUAL REPORT 2024-03-20
ANNUAL REPORT 2023-04-05
ANNUAL REPORT 2022-03-08
ANNUAL REPORT 2021-04-14
ANNUAL REPORT 2020-03-16
ANNUAL REPORT 2019-04-09
Florida Limited Liability 2018-01-29

Related by officers

GORTHI KALPANA

SRISAIRAM LLC

Gorthi Kalpana

SRISAIRAM LLC

Related by address

3155 SUNTREE BLVD, ROCKLEDGE, FL, 32955, US

EXECUTIVE NON-EMERGENCY TRANSPORTATION, INC. HECTOR OCASIO, LLC GARY MCCAULEY, LLC CARL SWANSON, LLC EDWARD DATO, LLC GLENN JABBAR, LLC EVER FONSECA, LLC MYRA L. AYALA, LLC EXECUTIVE SHUTTLE SERVICE, INC.

3155 SUNTREE BLVD, ROCKLEDGE, FL, 32955, US

EXECUTIVE NON-EMERGENCY TRANSPORTATION, INC. HECTOR OCASIO, LLC GARY MCCAULEY, LLC CARL SWANSON, LLC EDWARD DATO, LLC GLENN JABBAR, LLC EVER FONSECA, LLC MYRA L. AYALA, LLC EXECUTIVE SHUTTLE SERVICE, INC.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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