| Entity Name: | DIPAK SHAH MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 10 Jul 2002 (23 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P02000075037 |
| FEI/EIN Number | 010732192 |
| Address: | 14701 N FLORIDA AVE, TAMPA, FL, 33613 |
| Mail Address: | 14701 N FLORIDA AVE, TAMPA, FL, 33613 |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215091350 | 2006-12-21 | 2020-08-22 | 14701 N FLORIDA AVE, TAMPA, FL, 336131823, US | 14701 N FLORIDA AVE, TAMPA, FL, 336131823, US | |||||||||||||||||||
|
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| Phone | +1 813-265-2066 |
Authorized person
| Name | DIPAK SHAH |
| Role | OWNER |
| Phone | 8132652066 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 77640 |
| Number | BCBS |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Shah Dipak | Agent | 14701 N FLORIDA AVE, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| SHAH DIPAK M | Officer | 14701 N FLORIDA AVE, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| SHAH DIPAK M | Director | 14701 N FLORIDA AVE, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-03-29 | Shah, Dipak | No data |
| CANCEL ADM DISS/REV | 2007-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| AMENDMENT | 2007-03-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-02-26 |
| ANNUAL REPORT | 2014-02-28 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-01-30 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-01-06 |
| ANNUAL REPORT | 2009-04-29 |
| ANNUAL REPORT | 2008-05-07 |
| REINSTATEMENT | 2007-10-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
