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General NPI Number Information
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NPI Number | 1376934950
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Entity Type | Organization
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Legal Business Name | KENTUCKIANA FOOT AND ANKLE, PLLC
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1019 COMMERCE PKWY
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City | LA GRANGE
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State | KY
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Zip | 40031-8779
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Country | US
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Telephone | 844-692-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 4612 OUTER LOOP
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City | LOUISVILLE
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State | KY
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Zip | 40219-3971
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Country | US
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Telephone | 502-804-4811
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SYED A KHADER
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Credential |
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Telephone | 844-692-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 00310
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License Number State | KY
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