| Entity Name: | KHAJA ZAKI MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Sep 2021 (3 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L21000391466 |
| Address: | 5041 WESTSHORE DRIVE, NEW PORT RICHEY, FL, 34652, US |
| Mail Address: | 2134 ALT US 19, B, PALM HARBOR, FL, 34683, UN |
| ZIP code: | 34652 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114686227 | 2021-12-16 | 2023-06-14 | 2410 NORTHSIDE DR, CLEARWATER, FL, 337612236, US | 5041 WESTSHORE DR, NEW PORT RICHEY, FL, 346523043, US | |||||||||||||||||||||||
|
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| Phone | +1 727-499-0351 |
| Fax | 7277813312 |
| Phone | +1 727-809-3404 |
Authorized person
| Name | KHAJA ZAKI |
| Role | MEDICAL DOCTOR/OWNER |
| Phone | 7278093404 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 068556900 |
| State | FL |
| Name | Role |
|---|---|
| BRIDGESPAN PARTNERS LLC | Agent |
| Name | Role | Address |
|---|---|---|
| ZAKI KHAJA | Manager | 5041 WESTSHORE DRIVE, NEW PORT RICHEY, FL, 34652 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2021-09-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
