Healthcare Provider Details

I. General information

NPI: 1245281724
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 N MILL ST STE 100
NAPERVILLE IL
60563-2261
US

IV. Provider business mailing address

120 OSLER LOWER LEVEL
NAPERVILLE IL
60540-7429
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-8000
  • Fax: 630-646-8007
Mailing address:
  • Phone: 630-646-3388
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

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