| Name: | Dost M. Khattak, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 20 Oct 1981 (43 years ago) |
| Date of dissolution: | 31 May 2012 |
| Entity Number: | 000-084-572 |
| Register Number: | 000084572 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 930 FRANKLIN ST SUITE 209HUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154537553 | 2007-05-15 | 2020-08-22 | 333 WHITESPORT DR SW, SUITE 304, HUNTSVILLE, AL, 358016454, US | 333 WHITESPORT DR SW, SUITE 304, HUNTSVILLE, AL, 358016454, US | |||||||||||||||||||||||||
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| Phone | +1 256-880-0800 |
| Fax | 2568823556 |
Authorized person
| Name | MS. THERESA A JOHNSON |
| Role | INSURANCE CLERK |
| Phone | 2568800800 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| License Number | 9080 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | SOLO NPI NUMBER |
| Number | 1427005560 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DOST M. KHATTAK, M.D., P.C. RETIREMENT PLAN AND TRUST | 2009 | 630815674 | 2010-10-11 | DOST M. KHATTAK, M.D., P.C. | 5 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 630815674 |
| Plan administrator’s name | DOST M. KHATTAK, M.D., P.C. |
| Plan administrator’s address | 333 WHITESPORT DR., STE. 304, HUNTSVILLE, AL, 358013455 |
| Administrator’s telephone number | 2568800800 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-11 |
| Name of individual signing | DOST M. KHATTAK, PRESIDENT |
| Name | Role |
|---|---|
| KHATTAK, DOST M MD | Agent |
| Name | Role |
|---|---|
| KHATTAK, DOST M MD | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
