Provider Demographics
NPI:1164193710
Name:KENTUCKIANA FOOT AND ANKLE, PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA FOOT AND ANKLE, PLLC
Other - Org Name:KENTUCKY FOOT AND ANKLE SPECIALISTS
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 1:118 PATRIOT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9096
Mailing Address - Country:US
Mailing Address - Phone:502-349-5995
Mailing Address - Fax:502-349-5997
Practice Address - Street 1:118 PATRIOT DR STE 201
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9096
Practice Address - Country:US
Practice Address - Phone:502-349-5995
Practice Address - Fax:502-349-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies