Healthcare Provider Details

I. General information

NPI: 1164193710
Provider Name (Legal Business Name): KENTUCKIANA FOOT AND ANKLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PATRIOT DR STE 201
BARDSTOWN KY
40004-9096
US

IV. Provider business mailing address

118 PATRIOT DR STE 201
BARDSTOWN KY
40004-9096
US

V. Phone/Fax

Practice location:
  • Phone: 502-349-5995
  • Fax: 502-349-5997
Mailing address:
  • Phone: 502-349-5995
  • Fax: 502-349-5997

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 ABDUL KHADER
Title or Position: OWNER
Credential:
Phone: 812-725-7542