| Entity Name: | PHYSICIANS PROFESSIONAL ALLIANCE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Jun 2020 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 28 Nov 2022 (2 years ago) |
| Document Number: | L20000153653 |
| FEI/EIN Number | 85-1306538 |
| Address: | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| Mail Address: | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477179463 | 2020-06-25 | 2020-07-06 | 519 MEDICAL OAKS AVE, BRANDON, FL, 335115961, US | 519 MEDICAL OAKS AVE, BRANDON, FL, 335115961, US | |||||||||||||||||||
|
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| Phone | +1 813-685-7995 |
| Fax | 8136858802 |
Authorized person
| Name | DR. GOPAL S GRANDHIGE |
| Role | TREASURER |
| Phone | 8136846006 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Park, In Soon, M.D. | Agent | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| Name | Role | Address |
|---|---|---|
| Park, In Soon, DR. | President | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| Name | Role | Address |
|---|---|---|
| Itriago, Francisco H, Dr. | Treasurer | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| Name | Role | Address |
|---|---|---|
| Tapper, Donovan N, Dr. | Secretary | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| Name | Role | Address |
|---|---|---|
| Alpendre, Cristiano V, Dr. | Asst. Secretary | 519 MEDICAL OAKS AVENUE, BRANDON, FL 33511 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000102530 | TAMPA BAY REFLUX CENTER | ACTIVE | 2021-08-06 | 2026-12-31 | No data | 519 MEDICAL OAKS AVE, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-01-06 | Park, In Soon, M.D. | No data |
| LC AMENDMENT | 2022-11-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-01-06 |
| LC Amendment | 2022-11-28 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-03-09 |
| Florida Limited Liability | 2020-06-05 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
