IndividualActive
Edwin Itenberg, D.O.
NPI 1255508487 · Colon & Rectal Surgery Physician · Southfield, MI
Provider details
- NPI number
- 1255508487
- Entity type
- Individual
- Primary specialty
- Colon & Rectal Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 5101019112 (MI)
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
Southfield, MI 48075-4818
Registry dates
- Enumerated
- 2008-05-16
- Last updated
- 2012-12-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.