Individual
DR. EDWIN ROBERT ITENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
16001 W 9 MILE RD, FISHER BUILDING 3RD FLOOR, SOUTHFIELD, MI 48075-4818
(248) 849-6030
(248) 849-6039
Mailing address
16001 W 9 MILE RD, FISHER BUILDING 3RD FLOOR, SOUTHFIELD, MI 48075-4818
(248) 849-6030
(248) 849-6039
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5101019112
MI
208C00000X
Colon & Rectal Surgery Physician
Primary
5101019112
MI
Other
Enumeration date
05/16/2008
Last updated
12/05/2012
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