MEDICARE: KIAH EDWARDS

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	163W00000X	Registered Nurse	041529943	IL

General Provider Information

NPI Number	:	1316893910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIAH EDWARDS

Provider Business Mailing Address
First Line	:	627 S KILDARE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-3561
Country	:	US
Telephone Number	:	312-694-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1969 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3765
Country	:	US
Telephone Number	:	312-864-1000
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ KIAH EDWARDS ” Practice Location

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