Provider Demographics
NPI:1215648175
Name:EDWARDS, KEVIN BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRIAN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:19525 JANACEK CT STE 103
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-7100
Mailing Address - Country:US
Mailing Address - Phone:262-957-1967
Mailing Address - Fax:414-784-0188
Practice Address - Street 1:19525 JANACEK CT STE 103
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-7100
Practice Address - Country:US
Practice Address - Phone:262-957-1967
Practice Address - Fax:414-784-0188
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI32280-20207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology