| Entity Name: | SANDRA R. GOTMAN, D.P.M., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 14 Aug 1986 (38 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 30 Mar 2009 (16 years ago) |
| Document Number: | M36822 |
| FEI/EIN Number | 59-2714534 |
| Address: | 550 WEST 51 STREET, Miami Beach, FL 33140 |
| Mail Address: | 550 WEST 51 STREET, Miami Beach, FL 33140 |
| ZIP code: | 33140 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861634065 | 2009-04-02 | 2010-07-04 | 11760 SW 40TH ST, SUITE 616, MIAMI, FL, 331758100, US | 11760 SW 40TH ST, SUITE 616, MIAMI, FL, 331758100, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 305-229-9595 |
| Fax | 3052299596 |
Authorized person
| Name | SANDRA R GOTMAN |
| Role | PRESIDENT/ DOCTOR |
| Phone | 3052299596 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | PO 1678 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 87910 |
| Issuer | MEDICAID |
| Number | 029757700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOTMAN, SANDRA R | Agent | 550 WEST 51 STREET, Miami Beach, FL 33140 |
| Name | Role | Address |
|---|---|---|
| GOTMAN, SANDRA | President | 550 WEST 51 STREET, Miami Beach, FL 33140 |
| Name | Role | Address |
|---|---|---|
| GOTMAN, SANDRA | Secretary | 550 WEST 51 STREET, Miami Beach, FL 33140 |
| Name | Role | Address |
|---|---|---|
| Mechulan, Enrique Roberto | Mr | 550 WEST 51 STREET, Miami Beach, FL 33140 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000028548 | MIAMI FOOT AND ANKLE INSTITUTE | EXPIRED | 2012-03-22 | 2017-12-31 | No data | 11760 SW 40TH ST, SUITE 616, MIAMI, FL, 33175 |
| G11000070628 | MIAMI FOOT AND ANKLE INSTITUTE | EXPIRED | 2011-07-14 | 2016-12-31 | No data | 11760 SW 40ST, SUITE #616, MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-11 | 550 WEST 51 STREET, Miami Beach, FL 33140 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-11 | 550 WEST 51 STREET, Miami Beach, FL 33140 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-11 | 550 WEST 51 STREET, Miami Beach, FL 33140 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-03-20 | GOTMAN, SANDRA R | No data |
| CANCEL ADM DISS/REV | 2009-03-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-04-17 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
