Organization
DEACONESS ILLINOIS CLINIC, INC
Active
Other names
Deaconess Illinois Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE DILLMAN (SECRETARY TREASURER)
(812) 450-7399
Entity
Organization
Contact information
Practice address
3331 W DEYOUNG ST, MARION, IL 62959-5896
(812) 450-6815
Mailing address
600 MARY ST, EVANSVILLE, IN 47710-1658
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2083X0100X
Occupational Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/02/2022
Last updated
01/19/2023
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