| Entity Name: | LAKE FOOT CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 May 2005 (20 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P05000074653 |
| FEI/EIN Number | 202931451 |
| Address: | 629 S GROVE ST, EUSTIS, FL, 32726 |
| Mail Address: | 217 East Badger Ave., EUSTIS, FL, 32726, US |
| ZIP code: | 32726 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306015748 | 2008-02-29 | 2008-11-12 | 629 S GROVE ST, EUSTIS, FL, 32726, US | 629 S GROVE ST, EUSTIS, FL, 32726, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 352-589-1335 |
| Fax | 3525891336 |
Authorized person
| Name | DR. JAMES T ROTELLA |
| Role | PRESIDENT OWNER OF LAKE FOOT CLINIC |
| Phone | 3525891335 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO1193 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE GROUP NUMBER |
| Number | K8096 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROTELLA JAMES T | Agent | 217 East Badger Ave., EUSTIS, FL, 32726 |
| Name | Role | Address |
|---|---|---|
| ROTELLA JAMES T | President | 217 E. BADGER AVE., EUSTIS, FL, 32726 |
| Name | Role | Address |
|---|---|---|
| ROTELLA JAMES T | Treasurer | 217 E. BADGER AVE., EUSTIS, FL, 32726 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-22 | 629 S GROVE ST, EUSTIS, FL 32726 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-22 | 217 East Badger Ave., EUSTIS, FL 32726 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-22 |
| ANNUAL REPORT | 2015-03-06 |
| ANNUAL REPORT | 2014-04-17 |
| ANNUAL REPORT | 2013-04-02 |
| ANNUAL REPORT | 2012-03-25 |
| ANNUAL REPORT | 2011-01-30 |
| ANNUAL REPORT | 2010-04-22 |
| ANNUAL REPORT | 2009-04-15 |
| ANNUAL REPORT | 2008-04-13 |
| ANNUAL REPORT | 2007-05-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
