| Entity Name: | INNOVATIVE DIABETIC SOLUTIONS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Aug 2023 (2 years ago) |
| Document Number: | L23000374089 |
| FEI/EIN Number | 93-1464741 |
| Address: | 660 GLADES ROAD, 240, BOCA RATON, FL 33431--646 PB |
| Mail Address: | 660 GLADES ROAD, 240, BOCA RATON, FL 33431 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124712054 | 2023-06-05 | 2024-07-26 | 4317 INTRACOASTAL DRIVE, HIGHLAND BEACH, FL, 33487, US | 660 GLADES RD STE 240, BOCA RATON, FL, 334316466, US | |||||||||||||||||||
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| Phone | +1 561-715-2493 |
| Fax | 5613382176 |
| Phone | +1 561-368-2005 |
| Fax | 5613382178 |
Authorized person
| Name | DR. RICHARD ALEXIS CONLEN |
| Role | OWNER |
| Phone | 5613682005 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CONLEN, RICHARD A, MD | Agent | 660 GLADES ROAD, SUITE 240, BOCA RATON, FL 33431 |
| Name | Role | Address |
|---|---|---|
| CONLEN, RICHARD A | Authorized Member | 660 GLADES ROAD, SUITE 240, BOCA RATON, FL 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-07-15 | 660 GLADES ROAD, 240, BOCA RATON, FL 33431--646 PB | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-15 |
| Florida Limited Liability | 2023-08-09 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
