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General NPI Number Information
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NPI Number | 1710938295
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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 | 05/12/2006
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 3540 SEVEN BRIDGES DR STE 230
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City | WOODRIDGE
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State | IL
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Zip | 60517-1222
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Country | US
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Telephone | 630-964-9400
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Fax | 630-964-9375
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Provider Business Mailing Address
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Address Line | 3540 SEVEN BRIDGES DRIVE STE 230
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City | WOODRIDGE
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State | IL
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Zip | 60517-1222
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Country | US
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Telephone | 630-964-9400
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Fax | 630-964-9375
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM G. KOTTMAN
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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