NPI | 1326765090 |
---|---|
Doing Business As | DEACONESS IL CLINIC 17TH ST |
Entity Type | Organization |
Authorized Contact | KYLE DILLMAN Secretary / Treasurer 812-450-7399 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2022-10-24 |
Last Update Date | 2023-02-02 |