| Entity Name: | MICHELE L. SELSOR, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Jan 2003 (22 years ago) |
| Document Number: | P03000011200 |
| FEI/EIN Number | 161651740 |
| Address: | 5851 93RD AVENUE N, PINELLAS PARK, FL, 33782, US |
| Mail Address: | 5851 93RD AVENUE N, PINELLAS PARK, FL, 33782, US |
| ZIP code: | 33782 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962685743 | 2007-12-14 | 2010-03-02 | 4104 5TH AVE N, ST PETERSBURG, FL, 337136304, US | 4104 5TH AVE N, ST PETERSBURG, FL, 337136304, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 727-321-9488 |
| Fax | 7273212033 |
Authorized person
| Name | MICHELE L SELSOR |
| Role | PRESIDENT |
| Phone | 7273219488 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO2916 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 340214200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SELSOR MICHELE L | Agent | 5851 93RD AVENUE N, PINELLAS PARK, FL, 33782 |
| Name | Role | Address |
|---|---|---|
| SELSOR MICHELE L | President | 5851 93RD AVENUE N, PINELLAS PARK, FL, 33782 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-01 | 5851 93RD AVENUE N, PINELLAS PARK, FL 33782 | No data |
| CHANGE OF MAILING ADDRESS | 2020-05-01 | 5851 93RD AVENUE N, PINELLAS PARK, FL 33782 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-01 | 5851 93RD AVENUE N, PINELLAS PARK, FL 33782 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-03-23 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-01-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
