| Entity Name: | MALIK SPINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Nov 2022 (2 years ago) |
| Document Number: | L22000499436 |
| FEI/EIN Number | 92-1199697 |
| Address: | 1380 NE Miami Gardens Dr., Suite 155, North Miami Beach, FL, 33179, US |
| Mail Address: | 1380 NE Miami Gardens Dr., Suite 155, North Miami Beach, FL, 33179, US |
| ZIP code: | 33179 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629849914 | 2024-01-15 | 2024-03-14 | 1380 NE MIAMI GARDENS DR STE 155, NORTH MIAMI BEACH, FL, 331794747, US | 1380 NE MIAMI GARDENS DR STE 155, NORTH MIAMI BEACH, FL, 331794747, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-902-1663 |
| Fax | 3059016238 |
Authorized person
| Name | DR. ALI MALIK |
| Role | OWNER PHYSICAN |
| Phone | 3057616850 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | M82MP |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MALIK ALI | Agent | 1380 NE Miami Gardens Dr., North Miami Beach, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| MALIK ALI S | Manager | 1380 NE Miami Gardens Dr., North Miami Beach, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-16 | 1380 NE Miami Gardens Dr., Suite 155, North Miami Beach, FL 33179 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-16 | 1380 NE Miami Gardens Dr., Suite 155, North Miami Beach, FL 33179 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-16 | 1380 NE Miami Gardens Dr., Suite 155, North Miami Beach, FL 33179 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-01-23 |
| Florida Limited Liability | 2022-11-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
