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General NPI Number Information
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NPI Number | 1023195666
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Entity Type | Organization
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Legal Business Name | DIABETES CARE CENTER OF KENTUCKY
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 135 E MAXWELL ST SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40508-2678
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Country | US
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Telephone | 859-422-4343
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Fax | 859-422-4361
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Provider Business Mailing Address
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Address Line | PO BOX 23823
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City | LEXINGTON
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State | KY
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Zip | 40523-3823
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Country | US
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Telephone | 859-422-4343
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Fax | 859-422-4361
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Authorized Official
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Title or Position | ADMINISTRATOR OWNER
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Name | ANN S GILES
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Credential |
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Telephone | 859-422-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | KY
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