Healthcare Provider Details

I. General information

NPI: 1114066065
Provider Name (Legal Business Name): KENNETH LEE EDWARDS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 WARRENSVILLE CENTER ROAD 303
SHAKER HEIGHTS OH
44122-5227
US

IV. Provider business mailing address

3461 WARRENSVILLE CENTER RD STE 303
SHAKER HEIGHTS OH
44122-5227
US

V. Phone/Fax

Practice location:
  • Phone: 216-752-0727
  • Fax:
Mailing address:
  • Phone: 216-752-0727
  • Fax: 216-752-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-2580-E
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: