| Entity Name: | ESSAM ATTIA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 04 May 1992 (33 years ago) |
| Document Number: | V33584 |
| FEI/EIN Number | 65-0332593 |
| Address: | 210 JUPITER LAKES BLVD., BLDG. 3000, SUITE 201, JUPITER, FL 33458 |
| Mail Address: | 18167 SE RIDGEVIEW DRIVE, TEQUESTA, FL 33469 |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063702470 | 2011-04-19 | 2011-04-19 | 210 JUPITER LAKES BLVD STE 3201, JUPITER, FL, 334587189, US | 210 JUPITER LAKES BLVD STE 3201, JUPITER, FL, 334587189, US | |||||||||||||||||||||||||
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| Phone | +1 561-747-7330 |
| Fax | 5617473538 |
Authorized person
| Name | ESSAM ATTIA |
| Role | OWNER/PHYSICIAN |
| Phone | 5617477330 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0038314 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 066958000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ATTIA, ESSAM | Agent | 210 JUPITER LAKES BLVD., BLDG. 3000, SUITE 201, JUPITER, FL 33458 |
| Name | Role | Address |
|---|---|---|
| ATTIA, ESSAM MD | Director | 210 JUPITER LAKES BLVD. BLDG. 3000, #201, JUPITER, FL 33458 |
| Name | Role | Address |
|---|---|---|
| ATTIA, ESSAM MD | President | 210 JUPITER LAKES BLVD. BLDG. 3000, #201, JUPITER, FL 33458 |
| Name | Role | Address |
|---|---|---|
| ATTIA, SEHAM | Secretary | 210 JUPITER LAKES BLVD BLDG 3000 #201, JUPITER, FL 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-26 | 210 JUPITER LAKES BLVD., BLDG. 3000, SUITE 201, JUPITER, FL 33458 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
