| Entity Name: | WEST BROWARD INTERNAL MEDICINE, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Nov 2020 (4 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 23 Sep 2021 (3 years ago) |
| Document Number: | L20000367961 |
| FEI/EIN Number | 65-0703258 |
| Address: | 6451 W. COMMERCIAL BLVD, TAMARAC, FL 33319 |
| Mail Address: | 6451 W. COMMERCIAL BLVD, TAMARAC, FL 33319 |
| ZIP code: | 33319 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871765727 | 2008-04-01 | 2023-11-27 | 6451 W COMMERCIAL BLVD, TAMARAC, FL, 333192110, US | 6451 W COMMERCIAL BLVD, TAMARAC, FL, 333192110, US | |||||||||||||||||||
|
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| Phone | +1 954-720-1414 |
| Fax | 9547204727 |
Authorized person
| Name | DR. SHAHRAD MABOURAKH |
| Role | PHYSICIAN |
| Phone | 9547201414 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME67283 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| KAREN B. SCHAPIRA, PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| MABOURAKH, SHAHRAD, MD | Manager | 6451 WEST COMMERCIAL BLVD, TAMARAC, FL 33319 |
| MABOURAKH, RUTH | Manager | 6451 WEST COMMERCIAL BLVD, TAMARAC, FL 33319 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-29 | 6451 W. COMMERCIAL BLVD, TAMARAC, FL 33319 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-29 | 6451 W. COMMERCIAL BLVD, TAMARAC, FL 33319 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-29 | KAREN B. SCHAPIRA, PLLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-29 | 11523 PALMBRUSH TRAIL, SUITE 316, LAKEWOOD RANCH, FL 34202 | No data |
| NAME CHANGE AMENDMENT | 2021-09-23 | WEST BROWARD INTERNAL MEDICINE, PLLC | No data |
| MERGER | 2021-09-23 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000218559 |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-04-28 |
| Merger | 2021-09-23 |
| Name Change | 2021-09-23 |
| ANNUAL REPORT | 2021-05-01 |
| Florida Limited Liability | 2020-11-20 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
