Doctor Name: | KENNETH LEE EDWARDS |
NPI Number: | 1114066065 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 36-00-2580-E |
Business Practice Address: | 3461 Warrensville Center Road 303 Shaker Heights, OH - 441225227 |
Business Phone Number: | 2167520727 |
Business Fax Number: | |
Mailing Address: | 3461 Warrensville Center Road, 303 SHAKER HEIGHTS |
State: | OH |
Postal Code: | 441225227 |
Phone Number: | 2167520727 |
Fax Number: | |
NPI Enumeration Date: | 02/06/2007 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 36-00-2580-E |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |