Provider Demographics
NPI:1851636047
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:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-646-3388
Mailing Address - Street 1:120 OSLER
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7429
Mailing Address - Country:US
Mailing Address - Phone:630-646-3388
Mailing Address - Fax:630-548-6832
Practice Address - Street 1:24600 W 127TH ST
Practice Address - Street 2:STE 340, BLDG B
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9507
Practice Address - Country:US
Practice Address - Phone:815-676-2940
Practice Address - Fax:815-676-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty