Provider Demographics
NPI:1770820680
Name:KENTUCKIANA FOOT & ANKLE, PLLC
Entity type:Organization
Organization Name:KENTUCKIANA FOOT & ANKLE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:502-449-0108
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:502-968-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2024-07-31
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
KY7100236440Medicaid
KY6158030004Medicare NSC