| Entity Name: | MOGILISHETTY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jul 2020 (5 years ago) |
| Document Number: | L20000221904 |
| FEI/EIN Number | 85-2398209 |
| Address: | 13873 PINE VILLA LN, FORT MYERS, FL, 33912, US |
| Mail Address: | 10012 GULF CENTER DR, STE 5292, FORT MYERS, FL, 33913, US |
| ZIP code: | 33912 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972117109 | 2020-09-04 | 2022-11-11 | 3400 LEE BLVD STE 112, LEHIGH ACRES, FL, 339711309, US | 3400 LEE BLVD STE 112, LEHIGH ACRES, FL, 339711309, US | |||||||||||||||
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| Phone | +1 239-939-0999 |
| Fax | 2399391070 |
Authorized person
| Name | MELANIE WERST |
| Role | CREDENTIALING MANAGER |
| Phone | 2399390999 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MOGILISHETTY GAUTHAM M.D. | Agent | 13873 PINE VILLA LN, FORT MYERS, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| MOGILISHETTY GAUTHAM M.D. | Manager | 10012 GULF CENTER DR, STE 5292, FORT MYERS, FL, 33913 |
| Name | Role | Address |
|---|---|---|
| Dittrich Mary | President | 5851 Legacy Cir, Plano, TX, 75024 |
| Name | Role | Address |
|---|---|---|
| Weinberg Thomas L | Chairman | 5851 Legacy Cir, Plano, TX, 75024 |
| Name | Role | Address |
|---|---|---|
| Nottingham Steven M.D. | Secretary | 5851 Legacy Cir, Plano, TX, 75024 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000127484 | NEPHROLOGY ASSOCIATES | ACTIVE | 2020-10-01 | 2025-12-31 | No data | 10012 GULF CENTER DRIVE, STE 5292, FORT MYERS, FL, 33913 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-02-16 |
| Florida Limited Liability | 2020-07-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
