Provider Demographics
NPI:1114695061
Name:KENTUCKIANA FOOT AND ANKLE, PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA FOOT AND ANKLE, PLLC
Other - Org Name:TIPTON & UNRUE FOOT AND ANKLE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:KHADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-725-7542
Mailing Address - Street 1:6801 DIXIE HWY STE 134
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3952
Mailing Address - Country:US
Mailing Address - Phone:502-447-4500
Mailing Address - Fax:502-449-0108
Practice Address - Street 1:6801 DIXIE HWY STE 134
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3952
Practice Address - Country:US
Practice Address - Phone:502-447-4500
Practice Address - Fax:502-449-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies