Provider Demographics
NPI:1356632657
Name:EDWARD HEALTH VENTURES
Entity Type:Organization
Organization Name:EDWARD HEALTH VENTURES
Other - Org Name:EDWARD MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-646-3388
Mailing Address - Street 1:130 WEBER ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1519
Mailing Address - Country:US
Mailing Address - Phone:630-646-5777
Mailing Address - Fax:630-646-5729
Practice Address - Street 1:130 WEBER ROAD
Practice Address - Street 2:STE 100
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1519
Practice Address - Country:US
Practice Address - Phone:630-646-5777
Practice Address - Fax:630-646-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty