| Entity Name: | NULIFE MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Mar 2024 (a year ago) |
| Document Number: | L24000125531 |
| Address: | 502 S MACDILL AVE, TAMPA, FL, 33609, US |
| Mail Address: | 502 S MACDILL AVE, TAMPA, FL, 33609, US |
| ZIP code: | 33609 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750140885 | 2024-03-19 | 2024-03-19 | 502 S MACDILL AVE, TAMPA, FL, 336093039, US | 502 S MACDILL AVE, TAMPA, FL, 336093039, US | |||||||||||||
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| Phone | +1 813-465-9999 |
Authorized person
| Name | DR. VENKATA JAYAPRATAP BIREDDY |
| Role | MANAGER |
| Phone | 8134659999 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BIREDDY VENKATA | Agent | 502 S MACDILL AVE, TAMPA, FL, 33609 |
| Name | Role | Address |
|---|---|---|
| BIREDDY VENKATA | Manager | 502 S MACDILL AVE, TAMPA, FL, 33609 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
