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Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Other names
Deaconess Illinois Clinic 3411 Professional Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE DILLMAN (SECRETARY)
(812) 450-7399
Entity
Organization
Contact information
Practice address
3411 PROFESSIONAL PARK DR, MARION, IL 62959-6394
(618) 969-8630
(618) 969-8639
Mailing address
PO BOX 632330, CINCINNATI, OH 45263-2330
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/25/2023
Last updated
07/15/2026
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