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
209 CROSSROADS PL, MOUNT VERNON, IL 62864-6545
(618) 244-1937
(618) 241-9079
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
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/24/2022
Last updated
12/02/2022
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