Entity Name: | BROWARD INTERNAL MEDICINE, P.A. |
Jurisdiction: | FLORIDA |
Filing Type: | Domestic Profit |
Status: | Active |
Date Filed: | 23 Apr 2004 (21 years ago) |
Document Number: | P04000067424 |
FEI/EIN Number | 201049758 |
Address: | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 33351 |
Mail Address: | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 33351 |
ZIP code: | 33351 |
County: | Broward |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1821095621 | 2005-07-07 | 2011-09-22 | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 333517224, US | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 333517224, US | |||||||||||||||||||||||||||||||
|
Phone | +1 954-746-5678 |
Fax | 9547465555 |
Authorized person
Name | SOLING LI |
Role | PRESIDENT |
Phone | 9547465678 |
Taxonomy
Taxonomy Code | 207R00000X - Internal Medicine Physician |
License Number | OS8465 |
State | FL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 270532000 |
State | FL |
Issuer | GROUP IDENTIFICATION NUMBER |
Number | K6039 |
State | FL |
Name | Role | Address |
---|---|---|
LI SOLING | Agent | 8890 WEST OAKLAND PARK BLVD, SUNRISE, FL, 33351 |
Name | Role | Address |
---|---|---|
LI JULISSA | Chief Executive Officer | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 33351 |
Name | Role | Address |
---|---|---|
LI SOLING | President | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 33351 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
REGISTERED AGENT NAME CHANGED | 2023-03-04 | LI, SOLING | No data |
REGISTERED AGENT ADDRESS CHANGED | 2013-01-15 | 8890 WEST OAKLAND PARK BLVD, SUITE 203, SUNRISE, FL 33351 | No data |
CHANGE OF PRINCIPAL ADDRESS | 2008-01-04 | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL 33351 | No data |
CHANGE OF MAILING ADDRESS | 2008-01-04 | 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL 33351 | No data |
Name | Date |
---|---|
ANNUAL REPORT | 2024-03-30 |
ANNUAL REPORT | 2023-03-04 |
ANNUAL REPORT | 2022-04-28 |
ANNUAL REPORT | 2021-01-29 |
AMENDED ANNUAL REPORT | 2020-05-27 |
ANNUAL REPORT | 2020-01-15 |
ANNUAL REPORT | 2019-01-10 |
ANNUAL REPORT | 2018-01-10 |
ANNUAL REPORT | 2017-01-09 |
ANNUAL REPORT | 2016-01-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State