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

Deaconess Illinois Clinic, Inc

Organization Family Medicine Physician · NPI 1659097947

Deaconess Illinois Clinic, Inc is a Family Medicine Physician in Saint Louis, Missouri. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
3
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

1028 S Kirkwood Rd
Saint Louis, MO 63122-7222
Phone: (314) 287-6184
Fax: (314) 394-2253
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Interventional Cardiology Physician Taxonomy 207RI0011X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1659097947
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kyle Dillman — Secretary / Treasurer · (812) 450-7399
Other names Deaconess Illinois Clinic; Deaconess Illinois Clinic
NPI enumeratedOctober 18, 2022
Last updated in NPPESDecember 2, 2022
Certification dateDecember 2, 2022
Mailing addressPo Box 34156, Belfast, ME 04915-0619

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