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LAKESIDE FAMILY MEDICINE, P.A. - Florida Company Profile

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Company Details

Entity Name: LAKESIDE FAMILY MEDICINE, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 30 Dec 1997 (28 years ago)
Date of dissolution: 23 Sep 2016 (9 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2016 (9 years ago)
Document Number: P97000108987
FEI/EIN Number 593484779
Address: 18550 US HWY 441, MOUNT DORA, FL, 32757, US
Mail Address: 18550 US HWY 441, MOUNT DORA, FL, 32757, US
ZIP code: 32757
City: Mount Dora
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CHANG KHAI President 2295 WEATHERED WOOD, LEESBURG, FL, 34748
AUNG MA THUZAR Treasurer 2207 AITKIN LOOP, LEESBURG, FL, 34748
CHEEMA SHAHBAZ Secretary 1004 PEMBLE RD, LEESBURG, FL, 34748
ZAMAN WAHEEDUZ Director 2202 OLD TAVARES RD, LEESBURG, FL, 34748
BHATTARAI BIRENDRA Director 31845 SUN PARK CIRCLE, LEESBURG, FL, 34748
BISHT AJAY Director 31849 SUN PARK CIRLCE, LEESBURG, FL, 34748
CHANG KHAI Agent 18550 US HWY 441, MOUNT DORA, FL, 32757

National Provider Identifier

NPI Number:
1679732689

Authorized Person:

Name:
DR. GERALD EDWARD REYNOLDS
Role:
PRESIDENT OF LAKESIDE FAMILY MEDICI
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3525895904

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 - -
AMENDMENT 2014-10-03 - -
CHANGE OF PRINCIPAL ADDRESS 2014-10-03 18550 US HWY 441, MOUNT DORA, FL 32757 -
CHANGE OF MAILING ADDRESS 2014-10-03 18550 US HWY 441, MOUNT DORA, FL 32757 -
REGISTERED AGENT NAME CHANGED 2014-10-03 CHANG, KHAI -
REGISTERED AGENT ADDRESS CHANGED 2014-10-03 18550 US HWY 441, MOUNT DORA, FL 32757 -

Documents

Name Date
ANNUAL REPORT 2015-03-08
Amendment 2014-10-03
ANNUAL REPORT 2014-03-20
ANNUAL REPORT 2013-04-16
ANNUAL REPORT 2012-02-13
ANNUAL REPORT 2011-02-27
ANNUAL REPORT 2010-02-22
ANNUAL REPORT 2009-04-02
ANNUAL REPORT 2008-07-15
ANNUAL REPORT 2007-02-22

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Date of last update: 02 Aug 2025

Sources: Florida Department of State