| Entity Name: | MUNROE MEDICAL PROVIDER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Mar 2023 (2 years ago) |
| Document Number: | L23000160799 |
| FEI/EIN Number | 92-3867783 |
| Address: | 1995 BRIDGEWATER DRIVE, LAKE MARY, FL, 32746 |
| Mail Address: | 1995 BRIDGEWATER DRIVE, LAKE MARY, FL, 32746 |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588358857 | 2023-06-08 | 2023-06-08 | 1995 BRIDGEWATER DR, LAKE MARY, FL, 327466911, US | 1995 BRIDGEWATER DR, LAKE MARY, FL, 32746, US | |||||||||||||||
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| Phone | +1 386-473-9607 |
| Fax | 3868607216 |
Authorized person
| Name | BISHNU PRAKASH VERMA |
| Role | PHYSICIAN |
| Phone | 3864739607 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VERMA BISHNU PDR. | Agent | 1995 BRIDGEWATER DRIVE, LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| VERMA BISHNU P | President | 1995 BRIDGEWATER DRIVE, LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| VERMA ANITA | Secretary | 1995 BRIDGEWATER DRIVE, LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| VERMA ANITA | Treasurer | 1995 BRIDGEWATER DRIVE, LAKE MARY, FL, 32746 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| Florida Limited Liability | 2023-03-20 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
