Organization · Type 2 NPI

Deaconess Illinois Clinic, Inc

Family Medicine Physician · St. Louis, MO

NPI number 1659097947 Active

Practice location

1028 S Kirkwood Rd
St. Louis, MO 63122-7222

Call (314) 287-6184 Map

Fax (314) 394-2253

Mailing address

PO Box 34156
Belfast, ME 04915-0619

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed
Interventional Cardiology Physician	207RI0011X	None listed
Nurse Practitioner	363L00000X	None listed

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

8 other providers at this address

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NPI record

NPI: 1659097947
Entity type: Organization (Type 2)
Issued: Oct 18, 2022
Last updated: Dec 2, 2022
Status: Active

Other names

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Deaconess Illinois Clinic · doing business as
Deaconess Illinois Clinic · doing business as

Authorized official

Kyle Dillman
Secretary / Treasurer
(812) 450-7399

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1659097947

Deaconess Illinois Clinic, Inc's National Provider Identifier is 1659097947, issued on Oct 18, 2022. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in St. Louis, MO. The record was last updated on Dec 2, 2022.