| Entity Name: | MSDERMATOLOGY PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 Jun 2022 (3 years ago) |
| Document Number: | L22000288094 |
| FEI/EIN Number | 88-3012378 |
| Address: | 10075 JOG ROAD SUITE 306, BOYNTON BEACH, FL 33437 |
| Mail Address: | 10075 JOG ROAD SUITE 306, BOYNTON BEACH, FL 33437 |
| ZIP code: | 33437 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518691252 | 2022-07-09 | 2022-07-09 | 10075 S JOG RD STE 306, BOYNTON BEACH, FL, 334373537, US | 10075 S JOG RD STE 306, BOYNTON BEACH, FL, 334373537, US | |||||||||||||
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| Phone | +1 561-424-7546 |
Authorized person
| Name | DR. MICHAEL IAN SHIMAN |
| Role | AUTHORIZED MEMBER |
| Phone | 5614247546 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MSDERMATOLOGY 401(K) PLAN | 2023 | 883012378 | 2024-05-13 | MSDERMATOLOGY PLLC | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-13 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| FISCHLER, MICHAEL A, ESQ. | Agent | 1000 SOUTH ANDREWS AVENUE, FORT LAUDERDALE, FL 33316 |
| Name | Role | Address |
|---|---|---|
| SHIMAN, MICHAEL, M.D. | Authorized Member | 10075 JOG ROAD SUITE 306, BOYNTON BEACH, FL 33437 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000081598 | MOHS AND SKIN DERMATOLOGY | ACTIVE | 2022-07-08 | 2027-12-31 | No data | 10075 S JOG ROAD, SUITE 306, BOYNTON BEACH, FL, 33437 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-18 |
| ANNUAL REPORT | 2023-04-09 |
| Florida Limited Liability | 2022-06-24 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
