| Entity Name: | BURGUNDY PRIME INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Jul 2018 (7 years ago) |
| Document Number: | P18000060108 |
| FEI/EIN Number | 83-1241494 |
| Address: | 1337 South International Parkway, Suite 1301, LAKE MARY, FL, 32746, US |
| Mail Address: | 1337 South International Parkway, Suite 1301, LAKE MARY, FL, 32746, US |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720557150 | 2018-11-14 | 2018-11-14 | 430 WAYMONT CT STE 100, LAKE MARY, FL, 327466745, US | 430 WAYMONT CT STE 100, LAKE MARY, FL, 327466745, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 407-878-0022 |
| Fax | 4073694267 |
Authorized person
| Name | ABID MALIK |
| Role | PRESIDENT |
| Phone | 4077778084 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | No |
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084B0002X - Obesity Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0015X - Psychosomatic Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084S0012X - Sleep Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MALIK ABID | Agent | 1337 South International Parkway, LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| MALIK ABID | President | 1337 South International Parkway, LAKE MARY, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-15 | 1337 South International Parkway, Suite 1301, LAKE MARY, FL 32746 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-15 | 1337 South International Parkway, Suite 1301, LAKE MARY, FL 32746 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-15 | 1337 South International Parkway, Suite 1301, LAKE MARY, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-17 |
| ANNUAL REPORT | 2023-01-15 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-03-28 |
| ANNUAL REPORT | 2020-06-15 |
| ANNUAL REPORT | 2019-03-05 |
| Domestic Profit | 2018-07-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
