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	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9933040	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1578513511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD HEALTH VENTURES

Provider Business Mailing Address
First Line	:	120 OSLER
Second Line	:	LOWER LEVEL
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7429
Country	:	US
Telephone Number	:	630-646-3388
Fax Number	:	630-548-6832

Provider Business Practice Location Address
First Line	:	16519 S ROUTE 59
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2606
Country	:	US
Telephone Number	:	630-646-5020
Fax Number	:	630-646-5025

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM G. KOTTMAN
Credential	:
Telephone Number	:	630-646-3388

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	12/14/2015

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Directions to “EDWARD HEALTH VENTURES ” Practice Location

Language	Start Address	Practice Location

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