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Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Other names
Deaconess IL Clinic Russell St
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY / TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
1306 N RUSSELL ST, MARION, IL 62959-4570
(618) 997-2248
(618) 969-8585
Mailing address
PO BOX 34156, BELFAST, ME 04915-0619
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/24/2022
Last updated
01/26/2023
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