Individual provider · NPI-1

Dr. Edwin Robert Itenberg, D.O.

Colon & Rectal Surgery · Southfield, MI

NPI number1255508487
StatusActive
Last updated in NPPESDec 5, 2012

Details

NPI
1255508487
Entity type
Individual (NPI-1)
Name
Dr. Edwin Robert Itenberg
Credential
D.O.
Sex
Male
Sole proprietor
Yes
Enumeration date
May 16, 2008
Last updated
Dec 5, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208C00000X Colon & Rectal Surgery5101019112MIYes
208600000X Surgery5101019112MI

Practice location

16001 W 9 Mile Rd
Fisher Building 3rd Floor
Southfield, MI 48075-4818

Phone 248-849-6030 · Fax 248-849-6039

Mailing address

16001 W 9 Mile Rd
Fisher Building 3rd Floor
Southfield, MI 48075-4818

Phone 248-849-6030 · Fax 248-849-6039

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