| Entity Name: | ROBERT M. MANDELKORN, M.D., INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Jul 2010 (15 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 May 2023 (2 years ago) |
| Document Number: | P10000062098 |
| FEI/EIN Number | 273090538 |
| Address: | 6710 Winkler Road, SUITE 5, FORT MYERS, FL, 33919, US |
| Mail Address: | 6710 Winkler Road, SUITE 5, FORT MYERS, FL, 33919, US |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871807420 | 2010-08-05 | 2010-08-05 | 1510 ROYAL PALM SQUARE BLVD, STE 106, FORT MYERS, FL, 339191068, US | 1510 ROYAL PALM SQUARE BLVD, STE 106, FORT MYERS, FL, 339191068, US | |||||||||||||||||||||||||||||
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| Phone | +1 239-939-3937 |
| Fax | 2392758045 |
Authorized person
| Name | DR. ROBERT MARC MANDELKORN |
| Role | PRESIDENT |
| Phone | 2399393937 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME80929 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA MEDICAL LICENSE |
| Number | ME80929 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1457455990 |
| Name | Role | Address |
|---|---|---|
| MANDELKORN ROBERT MDr. | Agent | 6710 Winkler Road, FORT MYERS, FL, 33919 |
| Name | Role | Address |
|---|---|---|
| MANDELKORN ROBERT M | President | 17610 STERLING LAKE, FORT Myers, FL, 33967 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-26 | 6710 Winkler Road, SUITE 5, FORT MYERS, FL 33919 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-26 | 6710 Winkler Road, SUITE 5, FORT MYERS, FL 33919 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-26 | 6710 Winkler Road, SUITE 5, FORT MYERS, FL 33919 | No data |
| REINSTATEMENT | 2023-05-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 2020-10-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-03-03 | MANDELKORN, ROBERT M., Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| REINSTATEMENT | 2023-05-25 |
| ANNUAL REPORT | 2021-01-27 |
| REINSTATEMENT | 2020-10-13 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-02-20 |
| ANNUAL REPORT | 2014-03-03 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
