MICHAEL E. LUSTGARTEN, M.D., P.A.

Company Details

Entity Name:	MICHAEL E. LUSTGARTEN, M.D., P.A.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Inactive
Date Filed:	29 Sep 1982 (42 years ago)
Document Number:	G01749
FEI/EIN Number	592215873
Address:	MICHAEL E. LUSTGARTEN, 834 E. OCEAN BLVD., STUART, FL, 34994-2434
Mail Address:	3631 SE DOUBLETON DR, Stuart, FL, 34997-5621, US
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1588938484

2012-02-24

834 E OCEAN BLVD, STUART, FL, 349942428, US

Contacts

Phone	+1 772-286-2950
Fax	7722862339

Authorized person

Name	DR. MICHAEL E. LUSTGARTEN
Role	OWNER
Phone	7722862950

Taxonomy

Taxonomy Code	208800000X - Urology Physician
License Number	ME0036091
State	FL
Is Primary	Yes

Other Provider Identifiers

Issuer	RAIL ROAD MEDICARE
Number	340000180
State	FL
Issuer	MEDICAID
Number	065662300
State	FL

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2019

592215873

2020-08-21

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2020-08-21
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2020-08-21
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2018

592215873

2019-08-27

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2019-08-27
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2019-08-27
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2017

592215873

2018-06-06

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2018-06-06
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2018-06-06
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2016

592215873

2017-07-17

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2017-07-17
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2017-07-17
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2015

592215873

2016-07-11

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2016-07-11
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2016-07-11
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2014

592215873

2015-09-03

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2015-09-03
Name of individual signing	MICHAEL E LUSTGARTEN, MD
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2015-09-03
Name of individual signing	MICHAEL E LUSTGARTEN, MD
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2013

592215873

2014-03-31

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2014-03-31
Name of individual signing	MICHAEL E LUSTGARTEN, MD
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2014-03-31
Name of individual signing	MICHAEL E LUSTGARTEN, MD
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2012

592215873

2013-04-08

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Signature of

Role	Plan administrator
Date	2013-04-08
Name of individual signing	MICHAEL E LUSTGARTEN, MD
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2013-04-08
Name of individual signing	MICHAEL E LUSTGARTEN, MD
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2011

592215873

2012-07-16

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Plan administrator’s name and address

Administrator’s EIN	592215873
Plan administrator’s name	MICHAEL E. LUSTGARTEN, M.D., P.A.
Plan administrator’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428
Administrator’s telephone number	7722862950

Signature of

Role	Plan administrator
Date	2012-07-16
Name of individual signing	MICHAEL E LUSTGARTEN, MD, PA
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2012-07-16
Name of individual signing	MICHAEL E LUSTGARTEN, MD, PA
Valid signature	Filed with authorized/valid electronic signature

MICHAEL E. LUSTGARTEN, M.D., P.A., 401(K) PROFIT SHARING PLAN

2010

592215873

2011-09-19

MICHAEL E. LUSTGARTEN, M.D., P.A.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-10-01
Business code	621111
Sponsor’s telephone number	7722862950
Plan sponsor’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428

Plan administrator’s name and address

Administrator’s EIN	592215873
Plan administrator’s name	MICHAEL E. LUSTGARTEN, M.D., P.A.
Plan administrator’s address	834 EAST OCEAN BOULEVARD, STUART, FL, 349942428
Administrator’s telephone number	7722862950

Signature of

Role	Plan administrator
Date	2011-09-19
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2011-09-19
Name of individual signing	MICHAEL LUSTGARTEN
Valid signature	Filed with authorized/valid electronic signature

Agent

Name	Role	Address
LUSTGARTEN MICHAEL E	Agent	834 E. OCEAN BLVD., STUART, FL, 33494

Director

Name	Role	Address
LUSTGARTEN MICHAEL E	Director	834 E. OCEAN BLVD., STUART, FL, 34994

President

Name	Role	Address
LUSTGARTEN MICHAEL E	President	834 E. OCEAN BLVD., STUART, FL, 34994

Events

Event Type	Filed Date	Value	Description
VOLUNTARY DISSOLUTION	2023-02-09	No data	No data

Date of last update: 03 Feb 2025

Sources: Florida Department of State

MICHAEL E. LUSTGARTEN, M.D., P.A.

Company Details

National Provider Identifier

form 5500

Agent

Director

President

Events

Related by officers

Related by address