| Entity Name: | MEDICAL ASSOCIATES OF CENTRAL FLORIDA PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 May 2021 (4 years ago) |
| Date of dissolution: | 27 Dec 2021 (3 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 27 Dec 2021 (3 years ago) |
| Document Number: | M21000006468 |
| FEI/EIN Number | 870859308 |
| Address: | 1110 DRUID CIRCLE, LAKE WALES, FL, 33853, US |
| ZIP code: | 33853 |
| County: | Polk |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982370714 | 2021-08-20 | 2021-08-20 | 31810 HWY 27, HAINES CITY, FL, 338447617, US | 31810 HWY 27, HAINES CITY, FL, 338447617, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 863-877-2411 |
Authorized person
| Name | DWIGHT PEREZ |
| Role | CREDENTIALING SPECIALIST |
| Phone | 3057335713 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| SHINTO RICHARD A | Manager | 44 S BROADWAY STE 100, WHITE PLAINS, NY, 10601 |
| MALTON DOUGLAS | Manager | 44 S BROADWAY STE 100, WHITE PLAINS, NY, 10601 |
| Name | Role | Address |
|---|---|---|
| PRIZANT LESLIE | Authorized Person | 44 S BROADWAY STE 100, WHITE PLAINS, NY, 10601 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2021-12-27 | No data | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2021-12-27 |
| Foreign Limited | 2021-05-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
