Deaconess Illinois Clinic, INC

NPI #1992422539 in Sparta, Illinois

Provider Information

NPI Number: 1992422539
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: 818 E BROADWAY ST
City: Sparta
State: Illinois
ZIP Code: 62286-1820
Phone: (618) 939-4200

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Internal Medicine - Interventional Cardiology — Interventional Cardiology	207RI0011X
Family Medicine	207Q00000X	Primary

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