# TINA R. ENTWISTLE, D.P.M., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tina R. Entwistle, D.P.M., S.C.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740463678
- **Authorized official:** DR. TINA RENEE ENTWISTLE D.P.M. (PRESIDENT)
- **Authorized official phone:** (815) 227-0041

## Contact information

- **Practice address:** 6778 MILL RD, SUITE 100, ROCKFORD, IL 61108-2502
- **Practice address phone:** (815) 227-0041
- **Mailing address:** 6778 MILL RD, SUITE 100, ROCKFORD, IL 61108-2502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016-005194 | IL | Yes |

## Other

- **Enumeration date:** 12/13/2007
- **Last updated:** 01/11/2011