Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Other names
Deaconess IL Clinic Hamacher St
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY)
(812) 450-7399
Entity
Organization
Contact information
Practice address
509 HAMACHER ST STE 102, WATERLOO, IL 62298-1592
(812) 450-6815
(812) 450-6822
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
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/20/2022
Last updated
01/26/2023
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