Healthcare Provider Details

I. General information

NPI: 1467637264
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

801 S WASHINGTON ST 3 RD FLOOR
NAPERVILLE IL
60540-7430
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-5634
  • Fax: 630-548-0276
Mailing address:
  • Phone: 630-527-5359
  • Fax: 630-527-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. WILLIAM G. KOTTMAN
Title or Position: PRESIDENT
Credential:
Phone: 630-646-3388