| NPI | 1558088138 |
|---|---|
| Doing Business As | DEACONESS ILLINOIS CLINIC |
| Entity Type | Organization |
| Authorized Contact | KYLE DILLMAN Secretary / Treasurer 812-450-7399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-12-02 |