| Entity Name: | MARLEY MEDICAL PROVIDER GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 12 Jan 2022 (3 years ago) |
| Document Number: | P22000002702 |
| FEI/EIN Number | 87-4414073 |
| Address: | 2332 Galiano Street 2nd Floor, Coral Gables, FL 33134 |
| Mail Address: | 2332 Galiano Street 2nd Floor, Coral Gables, FL 33134 |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | MARLEY MEDICAL PROVIDER GROUP, P.A., MINNESOTA | 84851081-54ef-ec11-91bc-00155d32b93a | MINNESOTA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487301917 | 2022-03-04 | 2024-10-21 | 2332 GALIANO ST FL 2, CORAL GABLES, FL, 331345402, US | 2332 GALIANO ST FL 2, CORAL GABLES, FL, 331345402, US | |||||||||||||
|
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| Phone | +1 415-390-6008 |
Authorized person
| Name | VIKRAM BAKHRU |
| Role | PRESIDENT |
| Phone | 8888281871 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| BAKHRU, VIKRAM | Manager | 8605 SANTA MONICA BLVD, SUITE 68379 WEST HOLLYWOOD, FL 90069 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-09 | 2332 Galiano Street 2nd Floor, Coral Gables, FL 33134 | No data |
| CHANGE OF MAILING ADDRESS | 2024-12-09 | 2332 Galiano Street 2nd Floor, Coral Gables, FL 33134 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-03-09 |
| Domestic Profit | 2022-01-12 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
