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Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
Deaconess IL Specialty 4117 Water Tower
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
4117 S WATER TOWER PL STE C, MOUNT VERNON, IL 62864-6567
(618) 242-0672
(618) 242-0862
Mailing address
PO BOX 34266, BELFAST, ME 04915-0620
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207Y00000X
Otolaryngology Physician
—
—
231H00000X
Audiologist
—
—
Other
Enumeration date
11/04/2022
Last updated
01/26/2023
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