1083245542 NPI number — KENTUCKIANA FOOT & ANKLE PLLC

Table of content: (NPI 1083245542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083245542 NPI number — KENTUCKIANA FOOT & ANKLE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKIANA FOOT & ANKLE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KENTUCKY FOOT AND ANKLE SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083245542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 DIXIE HIGHWAY
Provider Second Line Business Mailing Address:
STE 134
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40258-3952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-447-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4644 CHAMBERLAIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-1160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-805-3338
Provider Business Practice Location Address Fax Number:
502-690-3017
Provider Enumeration Date:
02/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KHADER
Authorized Official First Name:
SYED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
502-968-2233

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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