Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Deaconess Illinois Clinic, Inc

Organization Family Medicine Physician · NPI 1063104206

Deaconess Illinois Clinic, Inc is a Family Medicine Physician in Marion, Illinois. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
4
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3411 Professional Park Dr
Marion, IL 62959-6394
Phone: (618) 969-8630
Fax: (618) 969-8639
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Pediatrics Physician Taxonomy 208000000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1063104206
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kyle Dillman — Secretary · (812) 450-7399
Other names Deaconess Illinois Clinic 3411 Professional Park
NPI enumeratedMay 25, 2023
Last updated in NPPESJuly 15, 2026
Certification dateJuly 15, 2026
Mailing addressPo Box 632330, Cincinnati, OH 45263-2330

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