Healthcare Provider Details

I. General information

NPI: 1477982767
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 N EOLA RD
AURORA IL
60502-9409
US

IV. Provider business mailing address

27555 DIEHL RD ENTRANCE B
WARRENVILLE IL
60555-3849
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6250
  • Fax: 630-236-2363
Mailing address:
  • Phone: 630-646-3950
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. BILL KOTTMAN
Title or Position: PRESIDENT
Credential:
Phone: 630-646-3950