| Entity Name: | INFECTIOUS DISEASES CONSULTANTS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 May 1999 (26 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 10 May 2018 (7 years ago) |
| Document Number: | P99000047018 |
| FEI/EIN Number | 650923588 |
| Address: | 21205 OLEAN BLVD, STE. A, PORT CHARLOTTE, FL, 33952 |
| Mail Address: | 21205 OLEAN BLVD, STE. A, PORT CHARLOTTE, FL, 33952, US |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043308141 | 2006-10-11 | 2022-02-08 | 21205 OLEAN BLVD STE A, PORT CHARLOTTE, FL, 339526756, US | 21205 OLEAN BLVD STE A, PORT CHARLOTTE, FL, 339526756, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 941-613-2800 |
| Fax | 9416132801 |
Authorized person
| Name | EILEEN RICHARD |
| Role | OFFICE MANAGER |
| Phone | 9416132800 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | ME0056397 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | 440002698 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | P00338188 |
| State | FL |
| Issuer | MEDICAID |
| Number | 271223700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAMIANI KARL G | Agent | 21205 OLEAN BLVD, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| Damiani Karl Dr. | President | 21205 OLEAN BLVD, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| Edeoga Ndubuisi Dr. | Vice President | 21205 OLEAN BLVD, PORT CHARLOTTE, FL, 33952 |
| Nguyen Luong PDr. | Vice President | 21205 OLEAN BLVD, PORT CHARLOTTE, FL, 33952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-01-20 | 21205 OLEAN BLVD, STE. A, PORT CHARLOTTE, FL 33952 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-01-20 | DAMIANI, KARL G | No data |
| NAME CHANGE AMENDMENT | 2018-05-10 | INFECTIOUS DISEASES CONSULTANTS, P.A. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-31 | 21205 OLEAN BLVD, STE. A, PORT CHARLOTTE, FL 33952 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-01-31 | 21205 OLEAN BLVD, SUITE A, PORT CHARLOTTE, FL 33952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-02-10 |
| AMENDED ANNUAL REPORT | 2019-07-02 |
| ANNUAL REPORT | 2019-03-26 |
| Name Change | 2018-05-10 |
| ANNUAL REPORT | 2018-01-16 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
