| Entity Name: | FAMILY PHYSICIAN GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 08 Oct 1993 (31 years ago) |
| Date of dissolution: | 23 Aug 1996 (28 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Aug 1996 (28 years ago) |
| Document Number: | P93000070028 |
| FEI/EIN Number | 65-0441596 |
| Mail Address: | 1100 PONCE DE LEON BLVD, CORAL GABLES, FL 33134 |
| Address: | 6445 S.W. 8 ST., #236, MIAMI, FL 33134 |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184701740 | 2006-11-01 | 2020-08-22 | 3391 S KIRKMAN RD, APT #1223, ORLANDO, FL, 328111943, US | 6320 OLD WINTER GARDEN RD, ORLANDO, FL, 328351381, US | |||||||||||||||||
|
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| Phone | +1 407-822-4350 |
Authorized person
| Name | VIJAYALAKSHMI POLAVARAPU |
| Role | HOSPITALIST |
| Phone | 4072811755 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| License Number | ME#91019 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HELLMAN, MAYNARD J. | Agent | 1100 PONCE DE LEON BLVD, CORAL GABLES, FL 33134 |
| Name | Role | Address |
|---|---|---|
| VALLADARES, JEANNETTE | Secretary | 6445 S.W. 8ST., MIAMI, FL |
| Name | Role | Address |
|---|---|---|
| VALLADARES, JEANNETTE | President | 6445 S.W. 8ST., MIAMI, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1995-06-23 | 6445 S.W. 8 ST., #236, MIAMI, FL 33134 | No data |
| CHANGE OF MAILING ADDRESS | 1994-04-01 | 6445 S.W. 8 ST., #236, MIAMI, FL 33134 | No data |
| REGISTERED AGENT NAME CHANGED | 1994-04-01 | HELLMAN, MAYNARD J. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1994-04-01 | 1100 PONCE DE LEON BLVD, CORAL GABLES, FL 33134 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 1995-06-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
