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BROWARD INTERNAL MEDICINE, P.A.

Company Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
LI SOLING Agent 8890 WEST OAKLAND PARK BLVD, SUNRISE, FL, 33351

Chief Executive Officer

Name Role Address
LI JULISSA Chief Executive Officer 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 33351

President

Name Role Address
LI SOLING President 8890 W OAKLAND PARK BLVD STE 203, SUNRISE, FL, 33351

Events

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

Documents

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