| Entity Name: | MARK G. WARREN, D.P.M., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 May 2002 (23 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 07 Nov 2017 (7 years ago) |
| Document Number: | P02000051350 |
| FEI/EIN Number | 010683542 |
| Address: | 821 S.W. 36TH AVE, BOYNTON BEACH, FL, 33435, UN |
| Mail Address: | 821 S.W. 36TH AVE, BOYNTON BEACH, FL, 33435, UN |
| ZIP code: | 33435 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801066188 | 2008-03-03 | 2021-09-09 | 821 SW 36TH AVE, BOYNTON BEACH, FL, 334358514, US | 5130 LINTON BLVD STE D3, DELRAY BEACH, FL, 334846595, US | |||||||||||||||||||||||||
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| Phone | +1 561-715-3106 |
| Fax | 5613364245 |
Authorized person
| Name | MARK G WARREN |
| Role | OWNER |
| Phone | 5617153106 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO 1194 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 04125710-0 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MINERLY KENNETH L | Agent | BLOCH, MINERLY & FEIN, P.L., BOCA RATON, FL, 33432 |
| Name | Role | Address |
|---|---|---|
| WARREN MARK G | Director | 821 S.W. 36TH AVE, BOYNTON BEACH, FL, 33435 |
| Name | Role | Address |
|---|---|---|
| Warren Jo A | Secretary | 821 S.W. 36TH AVE, BOYNTON BEACH, FL, 33435 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2017-11-07 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-11-07 | MINERLY, KENNETH LP.L. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-12 | 821 S.W. 36TH AVE, BOYNTON BEACH, FL 33435 UN | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-12 | 821 S.W. 36TH AVE, BOYNTON BEACH, FL 33435 UN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-05-11 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-03-04 |
| REINSTATEMENT | 2017-11-07 |
| ANNUAL REPORT | 2016-03-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
