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GREENBROOK MEDICAL PRACTICE, PLLC - Florida Company Profile

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Company Details

Entity Name: GREENBROOK MEDICAL PRACTICE, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 10 Aug 2021 (4 years ago)
Document Number: L21000360069
FEI/EIN Number 87-2125101
Address: 4030 HENDERSON BLVD, TAMPA, FL, 33629, US
Mail Address: 3404 S Beach Drive, Tampa, FL, 33629, US
ZIP code: 33629
City: Tampa
County: Hillsborough
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MACHHAR RAJ M.D. Agent 6811 FLORIDA HIGHWAY 54 WEST, NEW PORT RICHEY, FL, 34653
MACHHAR RAJ M.D. Manager 3404 S Beach Drive, Tampa, FL, 33629

National Provider Identifier

NPI Number:
1457014342
Certification Date:
2023-08-07

Authorized Person:

Name:
RAJ MACHHAR
Role:
CHIEF MEDICAL OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
No
Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-03-17 11200 E Dr Martin Luther King Jr Blvd, Suite 107, Seffner, FL 33584 -
CHANGE OF MAILING ADDRESS 2022-03-17 11200 E Dr Martin Luther King Jr Blvd, Suite 107, Seffner, FL 33584 -

Documents

Name Date
ANNUAL REPORT 2024-01-18
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-03-17
Florida Limited Liability 2021-08-10

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Date of last update: 03 Aug 2025

Sources: Florida Department of State