| Entity Name: | MICHAEL GLICK, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 21 Oct 1991 (33 years ago) |
| Last Event: | AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 03 May 2001 (24 years ago) |
| Document Number: | S90070 |
| FEI/EIN Number | 59-3086372 |
| Mail Address: | 4323 SERENE CIRCLE, FRUITLAND PARK, FL 34731 |
| Address: | 1501 HWY 441 N, SUITE 1102, THE VILLAGES, FL 32159 |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639188329 | 2006-08-05 | 2020-08-22 | 1501 N US HIGHWAY 441, SUITE 1102, THE VILLAGES, FL, 321598999, US | 1501 N US HIGHWAY 441, SUITE 1102, THE VILLAGES, FL, 321598999, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-753-5222 |
| Fax | 3527536483 |
Authorized person
| Name | MARIA GLICK |
| Role | OFFICE MANAGER |
| Phone | 3527535222 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0051531 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS FLORIDA PROVIDER ID |
| Number | 21793 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GLICK, MICHAEL M.D. | Agent | 1501 HWY 441N, STE 1102, THE VILLAGES, FL 32159 |
| Name | Role | Address |
|---|---|---|
| GLICK, MICHAEL M.D. | Director | 1501 HWY 441 N STE 1102, THE VILLAGES, FL 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-06-19 | 1501 HWY 441 N, SUITE 1102, THE VILLAGES, FL 32159 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-05-14 | 1501 HWY 441N, STE 1102, THE VILLAGES, FL 32159 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-04-28 | 1501 HWY 441 N, SUITE 1102, THE VILLAGES, FL 32159 | No data |
| AMENDED AND RESTATEDARTICLES | 2001-05-03 | No data | No data |
| REINSTATEMENT | 2001-04-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| REINSTATEMENT | 1996-09-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-16 |
| ANNUAL REPORT | 2022-05-02 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-08 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
