| Entity Name: | KIRAN R. MODI, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Oct 1995 (29 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P95000081966 |
| FEI/EIN Number | 593339594 |
| Address: | 3 Indian River Avenue, 1101, TITUSVILLE, FL, 32796, US |
| Mail Address: | 3 Indian River Avenue, 1101, TITUSVILLE, FL, 32796, US |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154622447 | 2010-11-03 | 2010-11-03 | 500 N WASHINGTON AVE, SUITE # 106, TITUSVILLE, FL, 327962759, US | 500 N WASHINGTON AVE, SUITE # 106, TITUSVILLE, FL, 327962759, US | |||||||||||||||
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| Phone | +1 321-264-9100 |
| Fax | 3212641164 |
Authorized person
| Name | KIRAN R MODI |
| Role | PRESIDENT |
| Phone | 3212649100 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MODI KIRAN R | Agent | 3 Indian River Avenue, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| MODI KIRAN R | PDR | 3 Indian River Avenue, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| MODI GITA K | VPDR | 3 Indian River Avenue, TITUSVILLE, FL, 32796 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-23 | 3 Indian River Avenue, 1101, TITUSVILLE, FL 32796 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-23 | 3 Indian River Avenue, 1101, TITUSVILLE, FL 32796 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-23 | 3 Indian River Avenue, 1101, TITUSVILLE, FL 32796 | No data |
| CANCEL ADM DISS/REV | 2005-10-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| REINSTATEMENT | 2000-11-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-03-31 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-01-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
