| Entity Name: | SANJAY K.MADAN MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Mar 2000 (25 years ago) |
| Document Number: | P00000026510 |
| FEI/EIN Number | 593630918 |
| Address: | 3190 MCMULLEN BOOTH ROAD, 201, CLEARWATER, FL, 33761 |
| Mail Address: | 310 SIGNATURE COURT, SAFETY HARBOR, FL, 34695 |
| ZIP code: | 33761 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639244999 | 2006-11-22 | 2020-08-22 | 3190 MCMULLEN BOOTH RD, STE 201, CLEARWATER, FL, 33761, US | 3190 MCMULLEN BOOTH RD, STE 201, CLEARWATER, FL, 33761, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 727-669-2969 |
| Fax | 7276697460 |
Authorized person
| Name | SANJAY K MADAN |
| Role | OWNER |
| Phone | 7276692969 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0073402 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC |
| Number | 34721 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MADAN SANJAY K | Agent | 310 SIGNATURE COURT, SAFETY HARBOR, FL, 34695 |
| Name | Role | Address |
|---|---|---|
| MADAN SANJAY K | President | 3190 MCMULLEN BOOTH ROAD, SUITE 201, CLEARWATER, FL, 33761 |
| Name | Role | Address |
|---|---|---|
| MADAN SANJAY K | Director | 3190 MCMULLEN BOOTH ROAD, SUITE 201, CLEARWATER, FL, 33761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2012-01-05 | 3190 MCMULLEN BOOTH ROAD, 201, CLEARWATER, FL 33761 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-05 | 310 SIGNATURE COURT, SAFETY HARBOR, FL 34695 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-01-05 | 3190 MCMULLEN BOOTH ROAD, 201, CLEARWATER, FL 33761 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-01-20 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
