Individual
KENNETH SCOTT BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2142 N COVE BLVD, TOLEDO, OH 43606-3895
(419) 291-4101
Mailing address
6896 W SNOWVILLE RD, BRECKSVILLE, OH 44141-3214
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34-00-7284
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000271429
ANTHEM
OH
01
—
000000372947
ANTHEM
OH
05
—
000000372947
—
MI
05
—
2181099
—
OH
01
—
341960760028
CARESOURCE
OH
05
—
4433727
—
MI
01
—
727173
BCHP
OH
05
—
810547599033
—
OH
Enumeration date
03/27/2006
Last updated
03/13/2018
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