Healthcare Provider Details

I. General information

NPI: 1326163767
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W. 127TH ST BLDG A, 2ND FLOOR
PLAINFIELD IL
60585-9508
US

IV. Provider business mailing address

27555 DIEHL RD.
WARRENVILLE IL
60555
US

V. Phone/Fax

Practice location:
  • Phone: 815-731-9190
  • Fax: 815-731-9191
Mailing address:
  • Phone: 630-646-3950
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier366700
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE GROUP NUMBER
# 2
Identifier2221474
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS

VIII. Authorized Official

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