| Entity Name: | PAUL KOTTURAN, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Nov 2020 (4 years ago) |
| Document Number: | L20000360343 |
| FEI/EIN Number | 85-3882527 |
| Address: | 7401 WILES RD SUITE 109, Boynton Beach, FL, 33067, US |
| Mail Address: | 7401 WILES RD SUITE 109, Boynton Beach, FL, 33067, US |
| ZIP code: | 33067 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598331191 | 2021-06-03 | 2021-06-03 | 3459 W WOOLBRIGHT RD, BOYNTON BEACH, FL, 334367246, US | 3459 W WOOLBRIGHT RD, BOYNTON BEACH, FL, 334367246, US | |||||||||||||||||||
|
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| Phone | +1 561-373-2200 |
Authorized person
| Name | DR. PAULSON KOTTURAN |
| Role | DOCTOR |
| Phone | 5613732200 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009868900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KOTTURAN PAUL | Agent | 6974 NW 63RD WAY, PARKLAND, FL, 33067 |
| Name | Role | Address |
|---|---|---|
| KOTTURAN PAUL | Manager | 6974 NW 63RD WAY, PARKLAND, FL, 33067 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-06-27 | 7401 WILES RD SUITE 109, Boynton Beach, FL 33067 | No data |
| CHANGE OF MAILING ADDRESS | 2022-06-27 | 7401 WILES RD SUITE 109, Boynton Beach, FL 33067 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-02-01 |
| Florida Limited Liability | 2020-11-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
