TINA R. ENTWISTLE D.P.M. P.C. NPI 1740463678

NPI Information

TINA R. ENTWISTLE, D.P.M., P.C. is a foot and ankle surgery podiatrist in Rockford, IL. TINA R. ENTWISTLE, D.P.M., P.C. NPI is 1740463678. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Tina R. Entwistle, D.p.m., S.c..

The provider's business location address is:

6778 MILL RD
SUITE 100
ROCKFORD, IL
ZIP 61108-502
Phone: (815) 227-0041

The provider's authorized official is Tina Renee Entwistle .
The authorized official title is President and has the following contact phone number (815) 227-0041.

The enumeration date for this NPI number is 12/13/2007 and was last updated on 1/11/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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