Organization
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
Active
Other names
St. Louis Cardiovascular, Deaconess IL Specialty Burns Ave
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
205 S BURNS AVE, SPARTA, IL 62286-1867
(618) 443-2858
(618) 939-4256
Mailing address
PO BOX 34266, BELFAST, ME 04915-0620
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/03/2022
Last updated
01/26/2023
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