Provider Demographics
NPI:1639436298
Name:KENTUCKIANA FOOT & ANKLE PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA FOOT & ANKLE PLLC
Other - Org Name:KENTUCKY FOOT AND ANKLE SPECIALISTS
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 1:6801 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:502-447-4500
Mailing Address - Fax:
Practice Address - Street 1:4420 DIXIE HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2988
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:2012-04-19
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00310332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100370200Medicaid
KY6158030005Medicare NSC