| Entity Name: | PRODOCTORS MEDICAL PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Sep 2021 (3 years ago) |
| Document Number: | L21000407608 |
| FEI/EIN Number | 87-2673114 |
| Address: | 1915 NE 45TH ST., SUITE 106, FORT LAUDERDALE, FL 33308 |
| Mail Address: | 1915 NE 45TH ST., SUITE 106, FORT LAUDERDALE, FL 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295498343 | 2021-10-15 | 2023-03-07 | 1915 NE 45TH ST STE 106, FORT LAUDERDALE, FL, 333085118, US | 1915 NE 45TH ST STE 106, FORT LAUDERDALE, FL, 333085118, US | |||||||||||||||||||||||||||
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| Phone | +1 305-286-6670 |
| Phone | +1 305-283-6670 |
Authorized person
| Name | PATRICK DREHER |
| Role | SOLE OWNER |
| Phone | 9546054391 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | 3177832 |
| State | FL |
| Issuer | MEDICAID |
| Number | 17814600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Dreher, Patrick, Dr. | Agent | 1915 NE 45th Street, 106, Fort Lauderdale, FL 33305 |
| Name | Role | Address |
|---|---|---|
| DREHER, PATRICK | Chief Executive Officer | 1915 NE 45TH ST., SUITE 106 FORT LAUDERDALE, FL 33308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-11 | 1915 NE 45th Street, 106, Fort Lauderdale, FL 33305 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-29 | Dreher, Patrick, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-04-29 |
| Florida Limited Liability | 2021-09-14 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
