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Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
Deaconess IL Specialty Doctors Park
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY / TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
8 DOCTORS PARK RD, MOUNT VERNON, IL 62864-6224
(618) 244-1380
(618) 244-1380
Mailing address
PO BOX 632331, CINCINNATI, OH 45263-2331
(618) 244-1380
(618) 244-1380
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/30/2025
Last updated
01/31/2025
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