Provider Demographics
NPI:1114177979
Name:KENTUCKIANA FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA FOOT AND ANKLE PLLC
Other - Org Name:KENTUCKY/INDIANA FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
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 1:7397 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-6178
Mailing Address - Country:US
Mailing Address - Phone:614-446-8175
Mailing Address - Fax:614-665-7624
Practice Address - Street 1:7397 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6178
Practice Address - Country:US
Practice Address - Phone:502-805-3338
Practice Address - Fax:502-805-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000590059OtherANTHEM
KY50022119OtherPASSPORT
KY7100061090Medicaid
INDO1639OtherRAILROAD MEDICARE
KYDQ5708OtherRAILROAD MEDICARE
IN200918130AMedicaid
KY50022119OtherPASSPORT
IN000000590059OtherANTHEM
KYDQ5708OtherRAILROAD MEDICARE
IN6158030001Medicare NSC
KY50022119OtherPASSPORT