Dr. Kenneth Anthony Dietrich, M.D., MBA
Pediatrics, Pediatric Critical Care Medicine in Elma, WA. Individual provider (NPI-1).
NPI number1245288752
StatusActive
Last updated in NPPESApr 4, 2019
Details
- NPI
- 1245288752
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kenneth Anthony Dietrich
- Credential
- M.D., MBA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 5, 2006
- Last updated
- Apr 4, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PEDIATRIC MEDICINE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2080P0203X | Pediatrics, Pediatric Critical Care Medicine | 27133 | WA | Yes |
Practice location
600 E Main StElma, WA 98541-9560
Phone 360-346-2240 · Fax 360-346-2192
Mailing address
600 E Main StElma, WA 98541-9560
Phone 360-346-2240 · Fax 360-346-2192
Other practice locations
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