Provider Demographics
NPI:1669707014
Name:EDWARD HEALTH VENTURES
Entity type:Organization
Organization Name:EDWARD HEALTH VENTURES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-646-3950
Mailing Address - Street 1:110 EAST COUNTRYSIDE PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1814
Mailing Address - Country:US
Mailing Address - Phone:815-731-9100
Mailing Address - Fax:815-731-9110
Practice Address - Street 1:110 EAST COUNTRYSIDE PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1814
Practice Address - Country:US
Practice Address - Phone:815-731-9100
Practice Address - Fax:815-731-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty