| Entity Name: | GHASSAN HASAN, MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Feb 2008 (17 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P08000019283 |
| FEI/EIN Number | 262031370 |
| Address: | 14510 SW 35 ST., MIRAMAR, FL, 33027 |
| Mail Address: | 14510 SW 35 ST., MIRAMAR, FL, 33027 |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245404144 | 2008-04-22 | 2008-10-17 | 14510 SW 35TH ST, MIRAMAR, FL, 330273748, US | 601 N FLAMINGO RD, SUITE 416, PEMBROKE PINES, FL, 330281015, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-803-8097 |
| Fax | 9544411403 |
| Phone | +1 954-392-8990 |
| Fax | 9543928909 |
Authorized person
| Name | GHASSAN A HASAN |
| Role | PRESIDENT |
| Phone | 3058038097 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 94778 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 276435100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HASAN GHASSAN | Agent | 14510 SW 35 ST., MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| HASAN GHASSAN | President | 14510 SW 35 ST., MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| HASAN GHASSAN | Director | 14510 SW 35 ST., MIRAMAR, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-04-29 |
| Domestic Profit | 2008-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
