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NPI Code Detail

MEDICARE: REBECCA PROEHL

MEDICARE: REBECCA PROEHL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036112475IL
2208000000XPediatrics Physician036112475IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427141787
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA PROEHL
Provider Business Mailing Address
First Line : 107 TREMONT ST
Second Line :
City : HOPEDALE
State : IL
Zip : 61747-7525
Country : US
Telephone Number : 815-842-3633
Fax Number : 815-844-6309
Provider Business Practice Location Address
First Line : 107 TREMONT ST
Second Line :
City : HOPEDALE
State : IL
Zip : 61747-7525
Country : US
Telephone Number : 309-449-4338
Fax Number : 309-449-4880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2006
Last Update Date : 10/18/2016

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Directions to “ REBECCA PROEHL ” Practice Location

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