Healthcare Provider Details

I. General information

NPI: 1114695061
Provider Name (Legal Business Name): KENTUCKIANA FOOT & ANKLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 DIXIE HWY STE 134
LOUISVILLE KY
40258-3952
US

IV. Provider business mailing address

6801 DIXIE HWY STE 134
LOUISVILLE KY
40258-3952
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-4500
  • Fax: 502-449-0108
Mailing address:
  • Phone: 502-447-4500
  • 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 ABDUL KHADER
Title or Position: OWNER
Credential:
Phone: 812-725-7542