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  5. RIZWANA THANAWALA, M.D., P.A.

RIZWANA THANAWALA, M.D., P.A.

Company Details

Entity Name: RIZWANA THANAWALA, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 07 May 1997 (28 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 20 Oct 2016 (8 years ago)
Document Number: P97000040962
FEI/EIN Number 59-3445857
Address: 4367 NW AMERICAN LANE, LAKE CITY, FL 32055
Mail Address: 4367 NW AMERICAN LANE, LAKE CITY, FL 32055
ZIP code: 32055
County: Columbia
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2023 593445857 2024-10-16 RIZWANA THANAWALA, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2022 593445857 2024-02-01 RIZWANA THANAWALA, M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2021 593445857 2022-10-14 RIZWANA THANAWALA, M.D., P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Signature of
Role Plan administrator
Date 2022-10-14
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2020 593445857 2021-10-12 RIZWANA THANAWALA, M.D., P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2019 593445857 2021-01-07 RIZWANA THANAWALA, M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Signature of
Role Plan administrator
Date 2021-01-07
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2018 593445857 2019-10-15 RIZWANA THANAWALA, M.D., P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2017 593445857 2018-10-15 RIZWANA THANAWALA, M.D., P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2016 593445857 2018-01-16 RIZWANA THANAWALA, M.D., P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Plan administrator’s name and address
Administrator’s EIN 593445857
Plan administrator’s name RIZWANA THANAWALA, M.D., P.A.
Plan administrator’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055
Administrator’s telephone number 3867586094

Signature of
Role Plan administrator
Date 2018-01-16
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2015 593445857 2016-07-22 RIZWANA THANAWALA, M.D., P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Plan administrator’s name and address
Administrator’s EIN 593445857
Plan administrator’s name RIZWANA THANAWALA, M.D., P.A.
Plan administrator’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055
Administrator’s telephone number 3867586094

Signature of
Role Plan administrator
Date 2016-07-22
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature
RIZWANA THANAWALA, M.D., P.A. 401(K) PROFIT SHARING PLAN 2014 593445857 2015-09-23 RIZWANA THANAWALA, M.D., P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 3867586094
Plan sponsor’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055

Plan administrator’s name and address
Administrator’s EIN 593445857
Plan administrator’s name RIZWANA THANAWALA, M.D., P.A.
Plan administrator’s address 4367 N.W. AMERICAN LANE, LAKE CITY, FL, 32055
Administrator’s telephone number 3867586094

Signature of
Role Plan administrator
Date 2015-09-23
Name of individual signing RIZWANA THANAWALA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
THANAWALA, RIZWANA Agent 4367 NW AMERICAN LANE, LAKE CITY, FL 32055

Director

Name Role Address
THANAWALA, RIZWANA MD Director 4367 NW AMERICAN LANE, LAKE CITY, FL 32055
DUTERTE, MITCHELL MD Director 4367 NW AMERICAN LANE, LAKE CITY, FL 32055

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000029297 PATHOLOGY ASSOCIATES OF NORTH FLORIDA EXPIRED 2015-03-20 2020-12-31 No data 4355 NW AMERICAN LANE, LAKE CITY, FL, 32055
G09000122135 GASTROENTEROLOGY ASSOCIATES EXPIRED 2009-06-17 2014-12-31 No data 4355 NW AMERICAN LANE, SUITE 1, LAKE CITY, FL, 32055, US

Events

Event Type Filed Date Value Description
REINSTATEMENT 2016-10-20 No data No data
REGISTERED AGENT NAME CHANGED 2016-10-20 THANAWALA, RIZWANA No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
CHANGE OF PRINCIPAL ADDRESS 2010-03-01 4367 NW AMERICAN LANE, LAKE CITY, FL 32055 No data
CHANGE OF MAILING ADDRESS 2010-03-01 4367 NW AMERICAN LANE, LAKE CITY, FL 32055 No data
REGISTERED AGENT ADDRESS CHANGED 2010-03-01 4367 NW AMERICAN LANE, LAKE CITY, FL 32055 No data
AMENDMENT 2004-06-21 No data No data

Documents

Name Date
ANNUAL REPORT 2024-04-13
ANNUAL REPORT 2023-04-01
ANNUAL REPORT 2022-04-29
ANNUAL REPORT 2021-04-09
ANNUAL REPORT 2020-05-24
ANNUAL REPORT 2019-02-09
ANNUAL REPORT 2018-01-18
ANNUAL REPORT 2017-03-20
REINSTATEMENT 2016-10-20
ANNUAL REPORT 2015-03-31

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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