| Entity Name: | INNOVATIVE DERMATOLOGY AND MOHS SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Feb 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 12 May 2015 (10 years ago) |
| Document Number: | L15000027555 |
| FEI/EIN Number | 47-3291857 |
| Address: | 3507 LEE BOULEVARD, SUITE 107, LEHIGH ACRES, FL, 33971 |
| Mail Address: | 3507 LEE BOULEVARD, SUITE 107, LEHIGH ACRES, FL, 33971 |
| ZIP code: | 33971 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487049722 | 2015-04-03 | 2015-04-03 | 3507 LEE BLVD, STE 107, LEHIGH ACRES, FL, 339711318, US | 3507 LEE BLVD, STE 107, LEHIGH ACRES, FL, 339711318, US | |||||||||||||||||||
|
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| Phone | +1 239-368-8071 |
| Fax | 2393688074 |
Authorized person
| Name | DR. ANDREW P KONTOS |
| Role | OWNER |
| Phone | 2393688071 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME96589 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| GSK REGISTERED AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| KONTOS ANDREW P | Manager | 3507 LEE BOULEVARD, SUITE 107, LEHIGH ACRES, FL, 33971 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-01-12 | GSK REGISTERED AGENTS, INC. | No data |
| LC AMENDMENT | 2015-05-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-05-12 | 3507 LEE BOULEVARD, SUITE 107, LEHIGH ACRES, FL 33971 | No data |
| CHANGE OF MAILING ADDRESS | 2015-05-12 | 3507 LEE BOULEVARD, SUITE 107, LEHIGH ACRES, FL 33971 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-10 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-04-15 |
| LC Amendment | 2015-05-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
