| Entity Name: | DAVID M. GUTSTEIN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 08 Dec 1995 (29 years ago) |
| Document Number: | P95000093396 |
| FEI/EIN Number | 650625135 |
| Mail Address: | 13181 PONDEROSA WAY, FORT MYERS, FL, 33907 |
| Address: | 15621 NEW HAMPSHIRE CT, FT MYERS, FL, 33908 |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447373659 | 2007-04-10 | 2013-06-04 | 15621 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084123, US | 15621 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084123, US | |||||||||||||||||||||||||
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| Phone | +1 239-466-8838 |
| Fax | 2394667669 |
Authorized person
| Name | DAVID M GUTSTEIN |
| Role | PRESIDENT |
| Phone | 2394668838 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | ME65573 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 376267000 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID M. GUTSTEIN, M.D., P.A., PROFIT SHARING PLAN | 2010 | 650625135 | 2011-08-30 | DAVID M. GUTSTEIN, M.D., P.A. | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 650625135 |
| Plan administrator’s name | DAVID M. GUTSTEIN, M.D., P.A. |
| Plan administrator’s address | 15621 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908 |
| Administrator’s telephone number | 2394668838 |
Signature of
| Role | Plan administrator |
| Date | 2011-08-30 |
| Name of individual signing | DAVID GUTSTEIN M D |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1996-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2394668838 |
| Plan sponsor’s address | 15621 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908 |
Plan administrator’s name and address
| Administrator’s EIN | 650625135 |
| Plan administrator’s name | DAVID M. GUTSTEIN, M.D., P.A. |
| Plan administrator’s address | 15621 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908 |
| Administrator’s telephone number | 2394668838 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-06 |
| Name of individual signing | DAVID GUTSTEIN M D |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GUTSTEIN DAVID M | Agent | 13181 PONDEROSA WAY, FT. MYERS, FL, 339077821 |
| Name | Role | Address |
|---|---|---|
| GUTSTEIN DAVID M | Director | 13181 PONDEROSA WAY, FT MYERS, FL, 339077821 |
| Name | Role | Address |
|---|---|---|
| GUTSTEIN DAVID M | President | 13181 PONDEROSA WAY, FT MYERS, FL, 339077821 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2001-07-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
