Healthcare Provider Details

I. General information

NPI: 1508816547
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 95TH ST SUITE 105
NAPERVILLE IL
60564-8459
US

IV. Provider business mailing address

27555 DIEHL RD
WARRENVILLE IL
60555
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6920
  • Fax: 630-646-6925
Mailing address:
  • Phone: 630-646-3950
  • Fax: 630-646-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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