| Entity Name: | MIIMII THAE DPM, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Mar 2024 (10 months ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 19 Aug 2024 (6 months ago) |
| Document Number: | P24000021676 |
| Address: | 4236 SW 124 TERRACE, MIRAMAR, FL, 33027, US |
| Mail Address: | 4236 SW 124 TERRACE, MIRAMAR, FL, 33027, US |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962247973 | 2024-07-01 | 2024-08-30 | 4236 SW 124TH TER, MIRAMAR, FL, 330276009, US | 381 N KROME AVE STE 112, HOMESTEAD, FL, 330306047, US | |||||||||||||||||||||||
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| Phone | +1 305-496-0596 |
| Phone | +1 305-246-4774 |
| Fax | 3052484086 |
Authorized person
| Name | DR. MIIMII THAE |
| Role | PRESIDENT /OWNER |
| Phone | 3054960596 |
Taxonomy
| Taxonomy Code | 261QP1100X - Podiatric Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PODIATRIC PHYSICIAN LICENSE |
| Number | PO4559 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROSALES LUIS F | Agent | 5931 NW 173 DR, HIALEAH, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| THAE MIIMII | President | 4236 SW 124 TERRACE, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| THAE MIIMII | Secretary | 4236 SW 124 TERRACE, MIRAMAR, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT AND NAME CHANGE | 2024-08-19 | MIIMII THAE DPM, P.A. | No data |
| Name | Date |
|---|---|
| Amendment and Name Change | 2024-08-19 |
| Domestic Profit | 2024-03-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
