MEDICARE: KENNETH RICHARD KOLES PHD DSC LAC

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	171100000X	Acupuncturist	65000028	OH

General Provider Information

NPI Number	:	1598821357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RICHARD KOLES PHD DSC LAC

Provider Business Mailing Address
First Line	:	2565 WARWICK RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-1331
Country	:	US
Telephone Number	:	216-397-4950
Fax Number	:	216-397-4044

Provider Business Practice Location Address
First Line	:	2565 WARWICK RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-1331
Country	:	US
Telephone Number	:	216-397-4950
Fax Number	:	216-397-4044

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	03/01/2021

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