Healthcare Provider Details

I. General information

NPI: 1184705238
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST STE B100
PLAINFIELD IL
60585-9511
US

IV. Provider business mailing address

120 OSLER LOWER LEVEL
NAPERVILLE IL
60540-7429
US

V. Phone/Fax

Practice location:
  • Phone: 815-731-9000
  • Fax: 815-731-9001
Mailing address:
  • Phone: 630-646-3388
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

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