Provider Demographics
NPI:1154808798
Name:KENTUCKIANA FOOT & ANKLE PLLC
Entity type:Organization
Organization Name:KENTUCKIANA FOOT & ANKLE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHADER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-968-2233
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:STE 134
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3952
Mailing Address - Country:US
Mailing Address - Phone:502-850-2447
Mailing Address - Fax:502-449-0108
Practice Address - Street 1:900 CHAMBERS BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2527
Practice Address - Country:US
Practice Address - Phone:502-331-6307
Practice Address - Fax:502-331-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies