| NPI | 1497462964 |
|---|---|
| Doing Business As | DEACONESS IL SPECIALTY EXPRESS BROADWAY ST |
| Entity Type | Organization |
| Authorized Contact | KYLE DILLMAN Secretary Treasurer 812-450-7399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2023-01-26 |