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St Michael Nephrology, PLLC

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Company Details

Name: St Michael Nephrology, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 16 Apr 2019 (6 years ago)
Financial Date End: 30 Apr 2020
Date dissolved: 03 Jul 2020
Entity Number: 3479270
Place of Formation: IDAHO
File Number: 662731
ZIP code: 83706
County: Ada County
Principal Address: APT 14 1674 S LOGGERS POND PL BOISE, ID 83706
Mailing Address: STE 100 999 W MAIN ST BOISE, ID 83702-9001

Agent

Name Role Address
Ernest Daniel M Dytiapco Agent 999 W MAIN ST, 100, BOISE, ID 83702

National Provider Identifier

NPI Number:
1144887050

Authorized Person:

Name:
DR. ERNEST DANIEL MORENO DYTIAPCO
Role:
NEPHROLOGIST
Phone:

Taxonomy:

Selected Taxonomy:
207RN0300X - Nephrology Physician
Is Primary:
Yes

Contacts:

Fax:
6265934751

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0003926753 2020-07-03
Amendment to Certificate 0003576194 2019-07-23
Statement of Conversion 0003488200 2019-04-29
Initial Filing 0003479270 2019-04-16

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Date of last update: 17 May 2025

Sources: Idaho Secretary of State