Individual
WARREN R ENTWISTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-5076
Mailing address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-5076
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101015260
MI
207P00000X
Emergency Medicine Physician
Primary
56606
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100020907
—
WI
05
—
1225004310
—
MI
Enumeration date
02/27/2006
Last updated
12/28/2021
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