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MARIUSZ J. KLIN, M.D., P.A.

MARIUSZ J. KLIN, M.D., P.A.

Company Details

Entity Name:	MARIUSZ J. KLIN, M.D., P.A.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Active
Date Filed:	15 Apr 2003 (22 years ago)
Last Event:	REINSTATEMENT
Event Date Filed:	31 Jan 2023 (2 years ago)
Document Number:	P03000042273
FEI/EIN Number	020688777
Address:	2202 STATE AVE, SUITE 301, PANAMA CITY, FL, 32405
Mail Address:	2202 State Ave, Ste 301, Panama City, FL, 32405, US
ZIP code:	32405
County:	Bay
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1508021684

2008-07-28

2008-09-23

2202 STATE AVE, SUITE 301, PANAMA CITY, FL, 324057601, US

2202 STATE AVE, SUITE 301, PANAMA CITY, FL, 324057601, US

Contacts

Phone	+1 850-215-7071
Fax	8502157073

Authorized person

Name	GRACE KLIN
Role	OFFICE MANAGER
Phone	8502157071

Taxonomy

Taxonomy Code	207RG0100X - Gastroenterology Physician
License Number	ME85851
State	FL
Is Primary	Yes

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2022

020688777

2024-07-19

MARIUSZ J. KLIN, M.D., P.A.

12

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2021

020688777

2023-02-15

MARIUSZ J. KLIN, M.D., P.A.

14

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2020

020688777

2021-10-12

MARIUSZ J. KLIN, M.D., P.A.

15

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2019

020688777

2021-01-14

MARIUSZ J. KLIN, M.D., P.A.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2018

020688777

2019-10-15

MARIUSZ J. KLIN, M.D., P.A.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2017

020688777

2019-02-28

MARIUSZ J. KLIN, M.D., P.A.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2016

020688777

2017-10-06

MARIUSZ J. KLIN, M.D., P.A.

12

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2015

020688777

2016-09-23

MARIUSZ J. KLIN, M.D., P.A.

9

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2014

020688777

2015-08-21

MARIUSZ J. KLIN, M.D., P.A.

11

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

MARIUSZ J. KLIN, M.D., P.A. 401K PROFIT SHARING TRUST

2013

020688777

2014-08-15

MARIUSZ J. KLIN, M.D., P.A.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-04-13
Business code	621111
Sponsor’s telephone number	8502157071
Plan sponsor’s address	2202 STATE AVE., SUITE 301, PANAMA CITY, FL, 32405

Agent

Name	Role	Address
Klin Mariusz J	Agent	1831 E 9th St, Lynn Haven, FL, 324443145

President

Name	Role	Address
KLIN MARIUSZ J	President	1831 E 9th St, Lynn Haven, FL, 32444

Events

Event Type	Filed Date	Value	Description
REINSTATEMENT	2023-01-31	No data	No data
REGISTERED AGENT NAME CHANGED	2023-01-31	Klin, Mariusz J	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	2022-09-23	No data	No data
CHANGE OF MAILING ADDRESS	2021-01-26	2202 STATE AVE, SUITE 301, PANAMA CITY, FL 32405	No data
REGISTERED AGENT ADDRESS CHANGED	2018-04-24	1831 E 9th St, Lynn Haven, FL 32444-3145	No data
CHANGE OF PRINCIPAL ADDRESS	2009-01-18	2202 STATE AVE, SUITE 301, PANAMA CITY, FL 32405	No data

Debts

Document Number	Status	Case Number	Name of Court	Date of Entry	Expiration Date	Amount Due	Plaintiff
J22000494015	TERMINATED	1000000935486	BAY	2022-10-21	2032-10-26	$ 3,012.41	STATE OF FLORIDA, DEPARTMENT OF REVENUE, PANAMA CITY SERVICE CENTER, 2480 SAINT ANDREWS BLVD, PANAMA CITY FL324052169

Documents

Name	Date
ANNUAL REPORT	2025-01-17
ANNUAL REPORT	2024-01-18
REINSTATEMENT	2023-01-31
ANNUAL REPORT	2021-01-26
ANNUAL REPORT	2020-06-26
ANNUAL REPORT	2019-03-05
ANNUAL REPORT	2018-04-24
ANNUAL REPORT	2017-01-10
ANNUAL REPORT	2016-03-15
ANNUAL REPORT	2015-01-27
ANNUAL REPORT	2014-05-01
ANNUAL REPORT	2013-03-08
ANNUAL REPORT	2012-03-21
ANNUAL REPORT	2011-04-22
ANNUAL REPORT	2010-01-17
ANNUAL REPORT	2009-01-18
ANNUAL REPORT	2008-01-27
ANNUAL REPORT	2007-01-04
ANNUAL REPORT	2006-04-12
ANNUAL REPORT	2005-02-02

Date of last update: 01 Feb 2025

Sources: Florida Department of State