# ADVANCED DIABETES MANAGEMENT PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689022972
- **Authorized official:** MICHAEL AINES APRN (OWNER)
- **Authorized official phone:** (502) 592-9254

## Contact information

- **Practice address:** 4119 BROWNS LN, BLDG 2, LOUISVILLE, KY 40220-1500
- **Practice address phone:** (800) 294-0807
- **Practice address fax:** (502) 681-9883
- **Mailing address:** 4119 BROWNS LN, BLDG 2, LOUISVILLE, KY 40220-1500
- **Mailing address phone:** (800) 294-0807
- **Mailing address fax:** (502) 681-9883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2016
- **Last updated:** 03/06/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100442930 | — | KY |