Deaconess Illinois Clinic, INC

NPI #1114644747 in Mount Vernon, Illinois

Provider Information

NPI Number: 1114644747
Entity Type: Organization
Organization Name: Deaconess Illinois Clinic, INC
Primary Specialty: Family Medicine
Enumeration Date: Oct 25, 2022
Last Updated: Dec 2, 2022

Practice Location

Address: 4113 S WATER TOWER PL
City: Mount Vernon
State: Illinois
ZIP Code: 62864-6293
Phone: (618) 241-9071

Authorized Official

Name: KYLE DILLMAN
Title: SECRETARY / TREASURER
Phone: (812) 450-7399

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Orthopaedic Surgery	207X00000X
Physician Assistant	363A00000X
Family Medicine	207Q00000X	Primary

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