Healthcare Provider Details

I. General information

NPI: 1154808798
Provider Name (Legal Business Name): KENTUCKIANA FOOT & ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 12/22/2023
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CHAMBERS BLVD
BARDSTOWN KY
40004-2527
US

IV. Provider business mailing address

6801 DIXIE HWY STE 134
LOUISVILLE KY
40258-3952
US

V. Phone/Fax

Practice location:
  • Phone: 502-331-6307
  • Fax: 502-331-6309
Mailing address:
  • Phone: 502-850-2447
  • Fax: 502-449-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SYED A KHADER
Title or Position: OWNER PHYSICIAN
Credential: DPM
Phone: 502-968-2233