Organization
BLUEGRASS PODIATRIC MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE LASORELLA (CREDENTIALING SUPERVISOR)
(513) 829-9333
Entity
Organization
Contact information
Practice address
9800 SHELBYVILLE RD STE 202, LOUISVILLE, KY 40223-5440
(502) 536-7224
(888) 419-6943
Mailing address
178 N EWING AVE, LOUISVILLE, KY 40206-2459
(502) 554-3792
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100335760
—
KY
Enumeration date
01/15/2015
Last updated
10/29/2024
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