Provider Demographics
NPI:1326836206
Name:DEACONESS ILLINOIS CLINIC, INC
Entity type:Organization
Organization Name:DEACONESS ILLINOIS CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-450-7399
Mailing Address - Street 1:PO BOX 632330
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2330
Mailing Address - Country:US
Mailing Address - Phone:618-219-1311
Mailing Address - Fax:
Practice Address - Street 1:700 LOGAN COLLEGE DRIVE
Practice Address - Street 2:J BUILDING
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918
Practice Address - Country:US
Practice Address - Phone:618-926-6698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty