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ICMD, P.A. - Florida Company Profile

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Company Details

Entity Name: ICMD, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Oct 2019 (6 years ago)
Document Number: P19000077324
FEI/EIN Number 84-3390240
Mail Address: 10770 S.E.173rd Street, Summerfield, FL, 34491, US
Address: 4767 CR 466 A, WILDWOOD, FL, 34785
ZIP code: 34785
City: Wildwood
County: Sumter
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
DELBAKHSH FARIBORZ M.D. President 10770 S.E.173rd Street, Summerfield, FL, 34491
Delbakhsh Mandy K Chief Operating Officer 10770 S.E.173rd Street, Summerfield, FL, 34491
Delbakhsh Fariborz Agent 10770 S.E.173rd Street, Summerfield, FL, 34491

National Provider Identifier

NPI Number:
1962091520
Certification Date:
2021-01-15

Authorized Person:

Name:
DR. FARIBORZ DELBAKHSH
Role:
OWNER, PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3527482700

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2022-03-18 4767 CR 466 A, WILDWOOD, FL 34785 -
REGISTERED AGENT ADDRESS CHANGED 2022-03-18 10770 S.E.173rd Street, Summerfield, FL 34491 -
REGISTERED AGENT NAME CHANGED 2021-04-29 Delbakhsh, Fariborz -

Documents

Name Date
ANNUAL REPORT 2024-04-28
ANNUAL REPORT 2023-03-09
ANNUAL REPORT 2022-03-18
ANNUAL REPORT 2021-04-29
ANNUAL REPORT 2020-06-08
Domestic Profit 2019-10-02

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Date of last update: 02 Aug 2025

Sources: Florida Department of State