=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225948912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROEHL MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2026
-----------------------------------------------------
Last Update Date | 09/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 MAXINE DR
-----------------------------------------------------
City | MORTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61550-2495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-220-5840
-----------------------------------------------------
Fax | 309-204-8162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 MAXINE DR
-----------------------------------------------------
City | MORTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61550-2495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-220-5840
-----------------------------------------------------
Fax | 309-204-8162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. TRENT PROEHL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 309-220-5840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------