| Entity Name: | MID FLORIDA GROUP OF SPECIALISTS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Mar 2022 (3 years ago) |
| Document Number: | L22000127159 |
| FEI/EIN Number | 88-1545199 |
| Address: | 1403 MEDICAL PLAZA DR STE 207, SANFORD, FL, 32771-1047 |
| Mail Address: | 1403 MEDICAL PLAZA DR STE 207, SANFORD, FL, 32771-1047 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588307094 | 2022-04-14 | 2024-10-29 | 1403 MEDICAL PLAZA DR STE 207, SANFORD, FL, 327711047, US | 1403 MEDICAL PLAZA DR STE 207, SANFORD, FL, 327711047, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 321-364-0728 |
| Fax | 3213640729 |
Authorized person
| Name | FUAD AFZAL |
| Role | AMBR |
| Phone | 3213640728 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | No |
| Taxonomy Code | 207RR0500X - Rheumatology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | ME94056 |
| State | FL |
| Issuer | MEDICAID |
| Number | ME125151 |
| State | FL |
| Issuer | COMMERCIAL |
| Number | ME94056 |
| State | FL |
| Issuer | COMMERCIAL |
| Number | ME128664 |
| State | FL |
| Issuer | MEDICAID |
| Number | 019373400 |
| State | FL |
| Issuer | MEDICAID |
| Number | ME128664 |
| State | FL |
| Issuer | COMMERCIAL |
| Number | ME125151 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AFZAL FUAD | Agent | 1403 MEDICAL PLAZA DR STE 207, SANFORD, FL, 327711047 |
| Name | Role | Address |
|---|---|---|
| AFZAL FUAD | Authorized Member | 1403 MEDICAL PLAZA DR STE 207, SANFORD, FL, 327711047 |
| HUSAIN SAYED | Authorized Member | 5022 MAPLE GLEN PL, SANFORD, FL, 32771 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-01-25 |
| Florida Limited Liability | 2022-03-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
