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Individual

TRENT D PROEHL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
107 TREMONT ST, HOPEDALE, IL 61747-7525
(309) 449-4338
(309) 449-4880
Mailing address
107 TREMONT ST, HOPEDALE, IL 61747-7525
(309) 449-4338
(309) 449-4880

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036111370
IL
208D00000X
General Practice Physician
Primary
036111370
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036111370
IL
Enumeration date
10/01/2006
Last updated
10/18/2016
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