Organization
TINA R. ENTWISTLE, D.P.M., P.C.
Active
Other names
Tina R. Entwistle, D.P.M., S.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TINA RENEE ENTWISTLE D.P.M. (PRESIDENT)
(815) 227-0041
Entity
Organization
Contact information
Practice address
6778 MILL RD, SUITE 100, ROCKFORD, IL 61108-2502
(815) 227-0041
Mailing address
6778 MILL RD, SUITE 100, ROCKFORD, IL 61108-2502
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016-005194
IL
Other
Enumeration date
12/13/2007
Last updated
01/11/2011
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