Provider Demographics
NPI:1164736815
Name:CARDINAL ORTHOTICS LLC
Entity type:Organization
Organization Name:CARDINAL ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FAROUK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSEFIZAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-749-8080
Mailing Address - Street 1:7410 NEW LA GRANGE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4871
Mailing Address - Country:US
Mailing Address - Phone:502-749-8080
Mailing Address - Fax:502-742-9340
Practice Address - Street 1:7410 NEW LA GRANGE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4871
Practice Address - Country:US
Practice Address - Phone:502-749-8080
Practice Address - Fax:502-742-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6707140001Medicare NSC