| Entity Name: | AXEL MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Apr 2023 (2 years ago) |
| Document Number: | L23000182635 |
| FEI/EIN Number | 92-3556187 |
| Address: | 4820 GRIFFIN BLVD, FORT MYERS, FL, 33908, US |
| Mail Address: | 4820 GRIFFIN BLVD, FORT MYERS, FL, 33908, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467140228 | 2023-04-28 | 2023-09-19 | 4820 GRIFFIN BLVD, FORT MYERS, FL, 339082016, US | 6811 PORTO FINO CIR, FORT MYERS, FL, 339124354, US | |||||||||||||||||||
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| Phone | +1 239-208-6648 |
| Fax | 8554623008 |
Authorized person
| Name | JESSELL LLORENTE |
| Role | DIRECTOR OF CREDENTIALING |
| Phone | 2392238129 |
Taxonomy
| Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SHETTY SUMEET | Agent | 4820 GRIFFIN BLVD, FORT MYERS, FL, 33908 |
| Name | Role | Address |
|---|---|---|
| SHETTY SUMEET | Manager | 4820 GRIFFIN BLVD, FORT MYERS, FL, 33908 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| Florida Limited Liability | 2023-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
