| Entity Name: | PROFESSIONAL PEDIATRICS, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Jun 2011 (14 years ago) |
| Document Number: | P11000052387 |
| FEI/EIN Number | 452420833 |
| Address: | 1050 US HWY 27 N, #5, CLERMONT, FL, 34714, US |
| Mail Address: | 265 CITRUS TOWER BLVD, SUITE 102, CLERMONT, FL, 34711, US |
| ZIP code: | 34714 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992378202 | 2021-07-23 | 2021-07-23 | 1050 US HIGHWAY 27 STE 5, CLERMONT, FL, 347147508, US | 1050 US HIGHWAY 27 STE 5, CLERMONT, FL, 347147508, US | |||||||||||||||||||
|
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| Phone | +1 352-404-8944 |
Authorized person
| Name | MOHAMMAD AFZAL |
| Role | OWNER |
| Phone | 3523943929 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004770701 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AFZAL MOHAMMAD | Agent | 265 CITRUS TOWER BLVD, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL MOHAMMAD | President | 265 CITRUS TOWER BLVD STE 102, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| AFZAL NADIA | Vice President | 265 CITRUS TOWER BLVD STE 102, CLERMONT, FL, 34711 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000052316 | PROFESSIONAL PEDIATRICS, INC. D/B/A PROFESSIONAL PEDIATRICS | EXPIRED | 2011-06-03 | 2016-12-31 | No data | 265 CITRUS TOWER BLVD STE 102, CLERMONT, FL, 34711 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-02-12 |
| ANNUAL REPORT | 2019-01-31 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-02-02 |
| ANNUAL REPORT | 2016-01-17 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
