Graduated: 2005
NPI: 1306829775
Practice Locations (2)
DEACONESS ILLINOIS CLINIC INC
1000 ELEVEN S
COLUMBIA, IL 622361077
6189392273
DEACONESS ILLINOIS CLINIC INC
509 HAMACHER ST
WATERLOO, IL 622981592
6189393939
Source: CMS National Downloadable File, September 2026.