| Entity Name: | FORT MYERS INTERNAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Sep 2012 (12 years ago) |
| Document Number: | L12000120257 |
| FEI/EIN Number | 46-1022634 |
| Address: | 16301 Shenandoah Circle, FORT MYERS, FL 33908 |
| Mail Address: | 16301 Shenandoah Circle, FORT MYERS, FL 33908 |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346588621 | 2013-01-22 | 2022-07-21 | 13861 PLANTATION RD UNIT 104, FT MYERS, FL, 33912, US | 13861 PLANTATION RD UNIT 104, FT MYERS, FL, 33912, US | |||||||||||||||||||
|
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| Phone | +1 239-225-1306 |
| Fax | 2397681313 |
Authorized person
| Name | ROBERT HADDAD |
| Role | OWNER |
| Phone | 2392251306 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME106006 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HADDAD, NATALIA | Agent | 16301 SHENANDOAH CIRCLE, fORT MYERS, FL 33908 |
| Name | Role | Address |
|---|---|---|
| HADDAD, ROBERT | Managing Member | 16301 SHENANDOAH CIRCLE, fORT MYERS, FL 33908 |
| Name | Role | Address |
|---|---|---|
| haddad, natalia | mgr | 16301 SHENANDOAH CIRCLE, fORT MYERS, FL 33908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-04 | 16301 SHENANDOAH CIRCLE, fORT MYERS, FL 33908 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-23 | 16301 Shenandoah Circle, FORT MYERS, FL 33908 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-23 | 16301 Shenandoah Circle, FORT MYERS, FL 33908 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
