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LAKE FAMILY MEDICINE & IMAGING PLLC - Florida Company Profile

Company Details

Entity Name: LAKE FAMILY MEDICINE & IMAGING PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

LAKE FAMILY MEDICINE & IMAGING PLLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act

Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 09 Apr 2020 (5 years ago)
Date of dissolution: 22 Sep 2023 (2 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 22 Sep 2023 (2 years ago)
Document Number: L20000100124
FEI/EIN Number 85-2072667

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 1403 Medical Plaza Dr., Suite 100, Sanford, FL, 32771, US
Mail Address: 1403 Medical Plaza Dr., Suite 100, Sanford, FL, 32771, US
ZIP code: 32771
County: Seminole
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
KANDAVANAM RAJ Manager 32136 RED TAIL BLVD, SORRENTO, FL, 32776
CARDENAS WILLYAM S Manager 4538 Rock Hill Loop, Apopka, FL, 32712
KANDAVANAM RAJ Agent 32136 RED TAIL BLVD, SORRENTO, FL, 32776

National Provider Identifier

NPI Number:
1164018743
Certification Date:
2020-12-17

Authorized Person:

Name:
RAJ KANDAVANAM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
4075595110

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 - -
CHANGE OF PRINCIPAL ADDRESS 2021-01-31 1403 Medical Plaza Dr., Suite 100, Sanford, FL 32771 -
CHANGE OF MAILING ADDRESS 2021-01-31 1403 Medical Plaza Dr., Suite 100, Sanford, FL 32771 -

Documents

Name Date
ANNUAL REPORT 2022-09-23
ANNUAL REPORT 2021-01-31
Florida Limited Liability 2020-04-09

Date of last update: 02 May 2025

Sources: Florida Department of State