| Entity Name: | LAKESIDE FAMILY MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Dec 1997 (27 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 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 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679732689 | 2008-06-04 | 2013-03-25 | 4685 N HIGHWAY 19A, MOUNT DORA, FL, 327572039, US | 4685 N HIGHWAY 19A, MOUNT DORA, FL, 327572039, US | |||||||||||||||
|
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| Phone | +1 352-589-5900 |
| Fax | 3525895904 |
Authorized person
| Name | DR. GERALD EDWARD REYNOLDS |
| Role | PRESIDENT OF LAKESIDE FAMILY MEDICI |
| Phone | 3525895900 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHANG KHAI | Agent | 18550 US HWY 441, MOUNT DORA, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| CHANG KHAI | President | 2295 WEATHERED WOOD, LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| AUNG MA THUZAR | Treasurer | 2207 AITKIN LOOP, LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| CHEEMA SHAHBAZ | Secretary | 1004 PEMBLE RD, LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| 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 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| AMENDMENT | 2014-10-03 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-10-03 | 18550 US HWY 441, MOUNT DORA, FL 32757 | No data |
| CHANGE OF MAILING ADDRESS | 2014-10-03 | 18550 US HWY 441, MOUNT DORA, FL 32757 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-10-03 | CHANG, KHAI | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-10-03 | 18550 US HWY 441, MOUNT DORA, FL 32757 | No data |
| 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 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
