| Entity Name: | EXCLUSIVE DERMATOLOGY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L23000441451 |
| FEI/EIN Number | 93-3565935 |
| Address: | 112 VIA VERDE WAY, PALM BEACH GARDENS, FL 33418 |
| Mail Address: | 112 VIA VERDE WAY, PALM BEACH GARDENS, FL 33418 |
| ZIP code: | 33418 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568236032 | 2023-11-14 | 2024-05-21 | 500 S AUSTRALIAN AVE STE 205, WEST PALM BEACH, FL, 334016235, US | 500 S AUSTRALIAN AVE STE 205, WEST PALM BEACH, FL, 334016235, US | |||||||||||||||||
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| Phone | +1 561-561-7546 |
Authorized person
| Name | STEVEN M ROTTER |
| Role | OWNER |
| Phone | 5615617546 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ROTTER, STEVEN M, MD | Agent | 112 VIA VERDE WAY, PALM BEACH GARDENS, FL 33418 |
| Name | Role | Address |
|---|---|---|
| ROTTER, STEVEN M, MD | Authorized Member | 112 VIA VERDE WAY, PALM BEACH GARDENS, FL 33418 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-06 |
| ANNUAL REPORT | 2024-02-09 |
| Florida Limited Liability | 2023-09-22 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
