MEDICARE: MR. MICHAEL 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1568395382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EDWARDS

Provider Business Mailing Address
First Line	:	316 PECAN CT
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-7944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10400 BLACKLICK EASTERN RD
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-8235
Country	:	US
Telephone Number	:	614-726-7359
Fax Number	:

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

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

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