Individual
JACOB EDENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(509) 385-6925
Mailing address
22101 MOROSS RD, DETROIT, MI 48236-2148
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301501530
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301110310
MI
Other
Enumeration date
06/16/2016
Last updated
05/29/2020
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