MEDICARE: EDWARD HEALTH VENTURES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	366700	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2221474	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1326163767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD HEALTH VENTURES

Provider Business Mailing Address
First Line	:	27555 DIEHL RD.
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555
Country	:	US
Telephone Number	:	630-646-3950
Fax Number	:	630-548-6832

Provider Business Practice Location Address
First Line	:	24600 W. 127TH ST
Second Line	:	BLDG A, 2ND FLOOR
City	:	PLAINFIELD
State	:	IL
Zip	:	60585-9508
Country	:	US
Telephone Number	:	815-731-9190
Fax Number	:	815-731-9191

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM G. KOTTMAN
Credential	:
Telephone Number	:	630-646-3950

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	09/03/2009

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Directions to “EDWARD HEALTH VENTURES ” Practice Location

Language	Start Address	Practice Location

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