Deaconess Illinois Clinic, INC

NPI #1790401081 in Benton, Illinois

Provider Information

NPI Number: 1790401081
Entity Type: Organization
Organization Name: Deaconess Illinois Clinic, INC
Primary Specialty: Family Medicine
Enumeration Date: Oct 18, 2022
Last Updated: Jan 26, 2023

Practice Location

Address: 205 BAILEY LN STE F
City: Benton
State: Illinois
ZIP Code: 62812-1921
Phone: (618) 882-4200

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X
Family Medicine	207Q00000X	Primary

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