MEDICARE: KENTUCKIANA FOOT & ANKLE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	207X00000X	Orthopaedic Surgery Physician
3	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	207RI0200X	Infectious Disease Physician
6	213ES0103X	Foot & Ankle Surgery Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DO1639	OTHER	IN	RAILROAD MEDICARE
6	DQ5708	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000590059	OTHER	IN	ANTHEM
3	50022119	OTHER	KY	PASSPORT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114177979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKIANA FOOT & ANKLE PLLC

Provider Business Mailing Address
First Line	:	7397 JEFFERSON BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-6178
Country	:	US
Telephone Number	:	614-446-8175
Fax Number	:	614-665-7624

Provider Business Practice Location Address
First Line	:	7397 JEFFERSON BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-6178
Country	:	US
Telephone Number	:	502-805-3338
Fax Number	:	502-805-7149

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	SYED A KHADER
Credential	:	DPM
Telephone Number	:	502-968-2233

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	11/13/2025

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