| Entity Name: | MITCHELL FORMAN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
MITCHELL FORMAN, M.D., P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 17 Mar 2003 (22 years ago) |
| Date of dissolution: | 17 Jan 2014 (11 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Jan 2014 (11 years ago) |
| Document Number: | P03000032188 |
| FEI/EIN Number |
710937927
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL, 33544 |
| Mail Address: | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL, 33544 |
| ZIP code: | 33544 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720392558 | 2010-08-04 | 2010-08-04 | 6414 RENWICK CIR, TAMPA, FL, 336471172, US | 1644 BRUCE B DOWNS BLVD, WESLEY CHAPEL, FL, 335448600, US | |||||||||||||||
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| Phone | +1 813-929-3600 |
| Fax | 8138668890 |
Authorized person
| Name | MITCHELL FORMAN |
| Role | OWNER |
| Phone | 8139293600 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FORMAN MITCHELL | Director | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL, 33544 |
| FORMAN PATRICIA | Officer | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL, 33544 |
| FORMAN MITCHELL | Agent | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL, 33544 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-01-17 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-05 | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL 33544 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2011-01-06 | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL 33544 | - |
| CHANGE OF MAILING ADDRESS | 2011-01-06 | 1644 BRUCE B DOWNS, WESLEY CHAPEL, FL 33544 | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000514245 | TERMINATED | 1000000228497 | HILLSBOROU | 2011-08-05 | 2021-08-10 | $ 965.85 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 6302 E DR MARTIN LUTHER KING JR BLVD S, TAMPA FL336191166 |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2014-01-17 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-01-05 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-01-11 |
| ANNUAL REPORT | 2009-01-16 |
| ANNUAL REPORT | 2008-01-16 |
| ANNUAL REPORT | 2007-01-04 |
| ANNUAL REPORT | 2006-01-31 |
| ANNUAL REPORT | 2005-07-01 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
