Healthcare Provider Details

I. General information

NPI: 1720363831
Provider Name (Legal Business Name): KEVIN JOSEPH EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 NE 1ST AVE APT 1903
MIAMI FL
33137-3663
US

IV. Provider business mailing address

3635 NE 1ST AVE APT 1903
MIAMI FL
33137-3663
US

V. Phone/Fax

Practice location:
  • Phone: 304-584-3538
  • Fax:
Mailing address:
  • Phone: 304-584-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01097999A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60608
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number119327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: