Basic Information
| Provider Information | |||||||||
| NPI: | 1114695061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KENTUCKIANA FOOT AND ANKLE, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TIPTON & UNRUE FOOT AND ANKLE INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 DIXIE HWY STE 134 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024474500 | ||||||||
| FaxNumber: | 5024490108 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 DIXIE HWY STE 134 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024474500 | ||||||||
| FaxNumber: | 5024490108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2021 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | KHADER | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
| AuthorizedOfficialMiddleName: | ABDUL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8127257542 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.