| Entity Name: | ANTONIO E. BLANCO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 31 Aug 1999 (25 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 09 Apr 2012 (13 years ago) |
| Document Number: | P99000077496 |
| FEI/EIN Number | 650945301 |
| Address: | 11440 N KENDALL DRIVE, SUITE 308, MIAMI, FL, 33176, US |
| Mail Address: | 11440 N KENDALL DRIVE, SUITE 308, MIAMI, FL, 33176, US |
| ZIP code: | 33176 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144315300 | 2006-10-04 | 2013-06-13 | 30334 OLD DIXIE HWY, HOMESTEAD, FL, 330333215, US | 30334 OLD DIXIE HWY, HOMESTEAD, FL, 330333215, US | |||||||||||||||||||||||||||||
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| Phone | +1 786-243-0149 |
| Fax | 7862432612 |
| Phone | +1 305-271-7660 |
| Fax | 3052717599 |
Authorized person
| Name | DR. ANTONIO E BLANCO |
| Role | PHYSICIAN |
| Phone | 3052793955 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0057421 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 257737201 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLANCO ANTONIO E | Agent | 11440 N KENDALL DRIVE, MIAMI, FL, 33176 |
| Name | Role | Address |
|---|---|---|
| BLANCO ANTONIO E | President | 11440 N KENDALL DRIVE, MIAMI, FL, 33176 |
| Name | Role | Address |
|---|---|---|
| BLANCO ANTONIO E | Director | 11440 N KENDALL DRIVE, MIAMI, FL, 33176 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-30 | 11440 N KENDALL DRIVE, SUITE 308, MIAMI, FL 33176 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-30 | 11440 N KENDALL DRIVE, SUITE 308, MIAMI, FL 33176 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-30 | 11440 N KENDALL DRIVE, SUITE 308, MIAMI, FL 33176 | No data |
| AMENDMENT | 2012-04-09 | No data | No data |
| REINSTATEMENT | 2003-06-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-23 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
