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  5. DAVID A. MACKOUL, M.D., P.A.

DAVID A. MACKOUL, M.D., P.A.

Company Details

Entity Name: DAVID A. MACKOUL, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 07 Oct 1998 (26 years ago)
Last Event: AMENDMENT
Event Date Filed: 05 Sep 2017 (7 years ago)
Document Number: P98000086048
FEI/EIN Number 650870284
Address: 206 SE 16TH PLACE, CAPE CORAL, FL, 33990
Mail Address: 206 SE 16TH PLACE, CAPE CORAL, FL, 33990
ZIP code: 33990
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1659389948 2006-08-03 2010-11-08 206 SE 16TH PL, CAPE CORAL, FL, 339901329, US 206 SE 16TH PL, CAPE CORAL, FL, 339901329, US

Contacts
Phone +1 239-829-1747
Fax 2395732006

Authorized person
Name DAVID MACKOUL
Role PRESIDENT
Phone 2395732001

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 258711402
State FL
Issuer MEDICAID
Number 258711400
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MACKOUL PEDIATRICS 401(K) PLAN 2015 650870284 2016-08-11 DAVID A. MACKOUL, M.D., P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
MACKOUL PEDIATRICS 401(K) PLAN 2014 650870284 2015-06-23 DAVID A. MACKOUL, M.D., P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Signature of
Role Plan administrator
Date 2015-06-23
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
MACKOUL PEDIATRICS 401(K) PLAN 2013 650870284 2014-07-22 DAVID A. MACKOUL, M.D., P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s DBA name DBA MACKOUL PEDIATRICS
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Plan administrator’s name and address
Administrator’s EIN 650870284
Plan administrator’s name DAVID A. MACKOUL, M.D., P.A.
Plan administrator’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
Administrator’s telephone number 2395732001

Signature of
Role Plan administrator
Date 2014-07-22
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
MACKOUL PEDIATRICS 401(K) PLAN 2012 650870284 2013-04-16 DAVID A. MACKOUL, M.D., P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s DBA name DBA MACKOUL PEDIATRICS
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Plan administrator’s name and address
Administrator’s EIN 650870284
Plan administrator’s name DAVID A. MACKOUL, M.D., P.A.
Plan administrator’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
Administrator’s telephone number 2395732001

Signature of
Role Plan administrator
Date 2013-04-16
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
MACKOUL PEDIATRICS 401(K) PLAN 2011 650870284 2012-07-13 DAVID A. MACKOUL, M.D., P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s DBA name DBA MACKOUL PEDIATRICS
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Plan administrator’s name and address
Administrator’s EIN 650870284
Plan administrator’s name DAVID A. MACKOUL, M.D., P.A.
Plan administrator’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
Administrator’s telephone number 2395732001

Signature of
Role Plan administrator
Date 2012-07-13
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
MACKOUL PEDIATRICS 401(K) PLAN 2010 650870284 2011-07-05 DAVID A. MACKOUL, M.D., P.A. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s DBA name DBA MACKOUL PEDIATRICS
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Plan administrator’s name and address
Administrator’s EIN 650870284
Plan administrator’s name DAVID A. MACKOUL, M.D., P.A.
Plan administrator’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
Administrator’s telephone number 2395732001

Signature of
Role Plan administrator
Date 2011-07-05
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
MACKOUL PEDIATRICS 401(K) PLAN 2009 650870284 2010-09-03 DAVID A. MACKOUL, M.D., P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s DBA name DBA MACKOUL PEDIATRICS
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Plan administrator’s name and address
Administrator’s EIN 650870284
Plan administrator’s name DAVID A. MACKOUL, M.D., P.A.
Plan administrator’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
Administrator’s telephone number 2395732001

Signature of
Role Plan administrator
Date 2010-09-03
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-03
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature
MACKOUL PEDIATRICS 401(K) PLAN 2009 650870284 2010-09-03 DAVID A. MACKOUL, M.D., P.A. 21
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 2395732001
Plan sponsor’s DBA name DBA MACKOUL PEDIATRICS
Plan sponsor’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329

Plan administrator’s name and address
Administrator’s EIN 650870284
Plan administrator’s name DAVID A. MACKOUL, M.D., P.A.
Plan administrator’s address 206 SE 16TH PLACE, CAPE CORAL, FL, 339901329
Administrator’s telephone number 2395732001

Signature of
Role Employer/plan sponsor
Date 2010-09-03
Name of individual signing DAVID A MACKOUL MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MACKOUL DAVID A Agent 206 SE 16TH PLACE, CAPE CORAL, FL, 33990

President

Name Role Address
MACKOUL DAVID President 206 SE 16TH PL, CAPE CORAL, FL, 33990

Secretary

Name Role Address
LOYSON AMBER C Secretary 206 SE 16TH PL, CAPE CORAL, FL, 33990

Director

Name Role Address
LOYSON AMBER C Director 206 SE 16TH PL, CAPE CORAL, FL, 33990

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000047816 MACKOUL PEDIATRICS, CAPE COARL ACTIVE 2023-04-14 2028-12-31 No data 206 SE 16TH PLACE, CAPE CORAL, FL, 33990

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2023-04-11 MACKOUL, DAVID A No data
AMENDMENT 2017-09-05 No data No data
REGISTERED AGENT ADDRESS CHANGED 2013-02-07 206 SE 16TH PLACE, CAPE CORAL, FL 33990 No data
CHANGE OF PRINCIPAL ADDRESS 2009-04-27 206 SE 16TH PLACE, CAPE CORAL, FL 33990 No data
CHANGE OF MAILING ADDRESS 2009-04-27 206 SE 16TH PLACE, CAPE CORAL, FL 33990 No data

Documents

Name Date
ANNUAL REPORT 2025-01-27
ANNUAL REPORT 2024-02-23
AMENDED ANNUAL REPORT 2023-04-11
ANNUAL REPORT 2023-01-24
ANNUAL REPORT 2022-02-08
ANNUAL REPORT 2021-03-01
ANNUAL REPORT 2020-02-24
ANNUAL REPORT 2019-02-18
ANNUAL REPORT 2018-03-16
Amendment 2017-09-05

Related by officers

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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