Individual
DR. ED ADEL ITAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 JOHN ST, SUITE M302, KALAMAZOO, MI 49007-5341
(269) 341-4890
(269) 341-4889
Mailing address
601 JOHN ST, SUITE M302, KALAMAZOO, MI 49007-5341
(269) 341-4890
(269) 341-4889
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301084241
MI
208C00000X
Colon & Rectal Surgery Physician
Primary
4301084241
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301084241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366645574
—
MI
01
—
1417961137
BCBS - BRONSON
MI
Enumeration date
06/06/2007
Last updated
11/27/2023
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