Provider Demographics
NPI:1710435862
Name:KENTUCKIANA FOOT & ANKLE PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA FOOT & ANKLE PLLC
Other - Org Name:DR SYED A KHADER PLLC
Other - Org Type:Former Legal Business Name
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:MD
Authorized Official - Phone:502-968-2233
Mailing Address - Street 1:6801 DIXIE HIGHWAY
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:502-968-2283
Practice Address - Street 1:427 US 31 W BYPASS
Practice Address - Street 2:STE 202
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1703
Practice Address - Country:US
Practice Address - Phone:270-796-6160
Practice Address - Fax:270-904-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6158030006Medicare NSC