Individual
DWAIN CLARK ILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
811 W 2ND ST, BLOOMINGTON, IN 47403-2251
(812) 353-3533
(812) 353-3204
Mailing address
PO BOX 2568, BLOOMINGTON, IN 47402-2568
(812) 353-3533
(812) 353-3202
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01027208
IN
Other
Enumeration date
01/22/2009
Last updated
01/22/2009
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