| NPI | 1740463678 |
|---|---|
| Former Legal Business Name | TINA R. ENTWISTLE, D.P.M., S.C. |
| Entity Type | Organization |
| Authorized Contact | TINA RENEE ENTWISTLE President 815-227-0041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016-005194) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2011-01-11 |