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General NPI Number Information
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NPI Number | 1215367099
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Entity Type | Organization
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Legal Business Name | EDWARD HEALTH VENTURES
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 10 MARTIN AVE STE 225
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City | NAPERVILLE
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State | IL
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Zip | 60540-6535
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Country | US
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Telephone | 630-355-5633
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Fax | 630-355-5215
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Provider Business Mailing Address
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Address Line | 27555 DIEHL RD ENTRANCE B
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City | WARRENVILLE
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State | IL
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Zip | 60555-3849
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Country | US
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Telephone | 630-646-3950
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Fax | 630-548-6832
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Authorized Official
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Title or Position | PRESIDENT
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Name | BILL KOTTMANN
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Credential |
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Telephone | 630-646-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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