Healthcare Provider Details

I. General information

NPI: 1043632136
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST STE B205
PLAINFIELD IL
60585-9507
US

IV. Provider business mailing address

27555 DIEHL RD ENTRANCE B
WARRENVILLE IL
60555-3849
US

V. Phone/Fax

Practice location:
  • Phone: 815-731-9120
  • Fax: 815-731-9124
Mailing address:
  • Phone: 630-646-3950
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. BILL KOTTMANN
Title or Position: PRESIDENT
Credential:
Phone: 630-646-3950