| Entity Name: | LAKE ALLERGY, ASTHMA & IMMUNOLOGY, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 May 2018 (7 years ago) |
| Document Number: | P18000046715 |
| FEI/EIN Number | 83-0695353 |
| Address: | 1822 SALK AVE., TAVARES, FL, 32778, US |
| Mail Address: | PO Box 987, Mount Dora, FL, 32756, US |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831682814 | 2018-06-13 | 2021-02-16 | 1822 SALK AVE, TAVARES, FL, 327784300, US | 1822 SALK AVE, TAVARES, FL, 327784300, US | |||||||||||||||||||||||||||
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| Phone | +1 954-609-0140 |
| Fax | 8882207924 |
| Phone | +1 525-531-7173 |
Authorized person
| Name | DR. ANDREW J COOKE |
| Role | PRESIDENT |
| Phone | 9546090140 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | ME118840 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 8G0U6 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE ALLERGY, ASTHMA & IMMUNOLOGY, PA 401(K) PS PLAN | 2023 | 830695353 | 2024-06-05 | LAKE ALLERGY, ASTHMA & IMMUNOLOGY, PA | 10 | |||||||||||||
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| LAKE ALLERGY, ASTHMA & IMMUNOLOGY, PA 401(K) PS PLAN | 2022 | 830695353 | 2023-04-13 | LAKE ALLERGY, ASTHMA & IMMUNOLOGY, PA | 6 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| Cooke Kimberly R | Agent | 2491 East Crooked Lake Club Blvd, Eustis, FL, 327262006 |
| Name | Role | Address |
|---|---|---|
| COOKE ANDREW JM.D. | President | 1822 SALK AVE., TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| COOKE ANDREW JM.D. | Secretary | 1822 SALK AVE., TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| COOKE ANDREW JM.D. | Director | 1822 SALK AVE., TAVARES, FL, 32778 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-04-05 | Cooke, Kimberly R | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-05 | 2491 East Crooked Lake Club Blvd, Eustis, FL 32726-2006 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-10 | 1822 SALK AVE., TAVARES, FL 32778 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-04-10 |
| Domestic Profit | 2018-05-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
