| Entity Name: | MODERN UROLOGY GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Feb 2022 (3 years ago) |
| Document Number: | L22000076236 |
| FEI/EIN Number | 88-0946209 |
| Address: | 3400 CORAL WAY, SUITE 500, MIAMI, FL 33145 |
| Mail Address: | 3400 CORAL WAY, SUITE 500, MIAMI, FL 33145 |
| ZIP code: | 33145 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437806197 | 2022-03-03 | 2022-07-24 | 13025 SW 62ND AVE, PINECREST, FL, 331567115, US | 3400 CORAL WAY STE 500, MIAMI, FL, 331453053, US | |||||||||||||||||
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| Phone | +1 305-215-3213 |
| Phone | +1 305-603-8684 |
| Fax | 8337562656 |
Authorized person
| Name | DR. ADAM MICHAEL DE FAZIO |
| Role | PHYSICIAN |
| Phone | 9547701666 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MODERN UROLOGY GROUP, LLC 401(K) | 2023 | 880946209 | 2024-07-22 | MODERN UROLOGY GROUP LLC | 5 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-22 |
| Name of individual signing | SHIRLEY HORNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| De Fazio, Adam | Agent | 3400 CORAL WAY, SUITE 500, MIAMI, FL 33145 |
| Name | Role | Address |
|---|---|---|
| VILARO, JOSE | Manager | 13025 SW 62ND AVENUE, PINECREST, FL 33156 |
| DE FAZIO, ADAM | Manager | 825 ALMERIA AVENUE, CORAL GABLES, FL 33134 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000029702 | MODERN UROLOGY | ACTIVE | 2022-03-07 | 2027-12-31 | No data | 13025 SW 62ND AVE, PINECREST, FL, 33156 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-17 | De Fazio, Adam | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-17 | 3400 CORAL WAY, SUITE 500, MIAMI, FL 33145 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-07-26 | 3400 CORAL WAY, SUITE 500, MIAMI, FL 33145 | No data |
| CHANGE OF MAILING ADDRESS | 2022-07-26 | 3400 CORAL WAY, SUITE 500, MIAMI, FL 33145 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-04-17 |
| Florida Limited Liability | 2022-02-15 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
