Provider Demographics
NPI:1205604469
Name:HAWKINS, KENNETH EDWIN
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EDWIN
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6746 EDGEMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4022
Mailing Address - Country:US
Mailing Address - Phone:216-870-7233
Mailing Address - Fax:
Practice Address - Street 1:6746 EDGEMOOR AVE
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-4022
Practice Address - Country:US
Practice Address - Phone:216-870-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRF638469172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver