| Entity Name: | MILLENNIUM PROVIDER GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Jan 2021 (4 years ago) |
| Document Number: | P21000001666 |
| FEI/EIN Number | 86-1468274 |
| Address: | 6321 DANIELS PARKWAY, SUITE 200, FORT MYERS, FL, 33912 |
| Mail Address: | 6321 DANIELS PARKWAY, SUITE 200, FORT MYERS, FL, 33912 |
| ZIP code: | 33912 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972234417 | 2022-06-23 | 2022-06-23 | 6321 DANIELS PKWY STE 200, FORT MYERS, FL, 339124773, US | 6321 DANIELS PKWY STE 200, FORT MYERS, FL, 339124773, US | |||||||||||||||
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| Phone | +1 855-674-7400 |
| Fax | 8556747401 |
Authorized person
| Name | CHASITY CHASE |
| Role | MARKET PRESIDENT |
| Phone | 8556747400 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HOLMES DAVID A | Agent | 99 NESBIT STREET, PUNTA GORDA, FL, 33950 |
| Name | Role | Address |
|---|---|---|
| Dosoretz Arie Dr. | Director | 6321 DANIELS PARKWAY, SUITE 200, FORT MYERS, FL, 33912 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-08-31 |
| Domestic Profit | 2021-01-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
