MEDICARE: KENNETH LEE EDWARDS D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36-00-2580-E	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000116438	OTHER	OH	ANTHEM BC & BS

General Provider Information

NPI Number	:	1114066065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LEE EDWARDS D.P.M.

Provider Business Mailing Address
First Line	:	3461 WARRENSVILLE CENTER RD STE 303
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5227
Country	:	US
Telephone Number	:	216-752-0727
Fax Number	:	216-752-0727

Provider Business Practice Location Address
First Line	:	3461 WARRENSVILLE CENTER ROAD
Second Line	:	303
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5227
Country	:	US
Telephone Number	:	216-752-0727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/09/2026

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Directions to “ KENNETH LEE EDWARDS D.P.M.” Practice Location

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