| Entity Name: | NANGI SHORES MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Jan 2012 (13 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: | P12000006863 |
| FEI/EIN Number | 80-0775857 |
| Address: | 9526 NE 2ND AVENUE, MIAMI SHORES, FL, 33138, US |
| Mail Address: | 9526 NE 2ND AVENUE, MIAMI SHORES, FL, 33138, US |
| ZIP code: | 33138 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063769412 | 2012-08-04 | 2012-08-04 | 9999 NE 2ND AVE STE 214, MIAMI SHORES, FL, 331382345, US | 9999 NE 2ND AVE STE 214, MIAMI SHORES, FL, 331382345, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 305-384-8789 |
| Fax | 7869534169 |
Authorized person
| Name | DR. ALPHONSE G DUFRENY |
| Role | PHYSICIAN |
| Phone | 3057569392 |
Taxonomy
| Taxonomy Code | 172V00000X - Community Health Worker |
| License Number | ME85072 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1356311822 |
| State | FL |
| Issuer | MEDICAID |
| Number | 267153100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DUFRENY JEAN E | Agent | 12 REDWOOD CIRCLE, PLANTATION, FL, 33317 |
| Name | Role | Address |
|---|---|---|
| DUFRENY ALPHONSE G | President | 9526 NE 2ND AVENUE, MIAMI SHORES, FL, 33138 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-26 | 9526 NE 2ND AVENUE, 202 B, MIAMI SHORES, FL 33138 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-26 | 9526 NE 2ND AVENUE, 202 B, MIAMI SHORES, FL 33138 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-26 |
| ANNUAL REPORT | 2015-04-14 |
| ANNUAL REPORT | 2014-03-31 |
| ANNUAL REPORT | 2013-09-20 |
| Domestic Profit | 2012-01-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
