| Entity Name: | KATHARIGUPPA VENKATARAM, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Jul 2000 (25 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P00000065653 |
| FEI/EIN Number | 593647698 |
| Mail Address: | 17213 Breeders Cup Dr, ODESSA, FL, 33556, US |
| Address: | 17213 Breeders Cup Dr, Odessa, FL, 33556, US |
| ZIP code: | 33556 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053604827 | 2011-05-26 | 2011-12-05 | 208 CRYSTAL GROVE BLVD, LUTZ, FL, 335486460, US | 208 CRYSTAL GROVE BLVD, LUTZ, FL, 335486460, US | |||||||||||||||||||||||||
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| Phone | +1 813-949-4991 |
| Fax | 8139494986 |
Authorized person
| Name | DR. KATHARIGUPPA VENKATARAM |
| Role | DIRECTOR |
| Phone | 8139494991 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME73717 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 260523600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VENKATARAM JAYA | Agent | 17213 Breeders Cup Dr, ODESSA, FL, 33556 |
| Name | Role | Address |
|---|---|---|
| VENKATARAM KATHARIGUPPA | Director | 17213 Breeders Cup Dr, ODESSA, FL, 33556 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-14 | 17213 Breeders Cup Dr, Odessa, FL 33556 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-10 | 17213 Breeders Cup Dr, Odessa, FL 33556 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-10 | 17213 Breeders Cup Dr, ODESSA, FL 33556 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-03-31 | VENKATARAM, JAYA | No data |
| NAME CHANGE AMENDMENT | 2000-10-05 | KATHARIGUPPA VENKATARAM, M.D., P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-11 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-14 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-04-10 |
| ANNUAL REPORT | 2014-03-07 |
| ANNUAL REPORT | 2013-04-05 |
| ANNUAL REPORT | 2012-02-13 |
| ANNUAL REPORT | 2011-03-31 |
| ANNUAL REPORT | 2010-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
