Kelly Dietrick
Physician Assistant in Chicago, IL. Individual provider (NPI-1).
NPI number1265393003
StatusActive
Last updated in NPPESNov 20, 2025
Details
- NPI
- 1265393003
- Entity type
- Individual (NPI-1)
- Name
- Kelly Dietrick
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 20, 2025
- Certification date
- Nov 20, 2025
- Last updated
- Nov 20, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085-011805 | IL | Yes |
Practice location
6140 N Broadway StChicago, IL 60660-2538
Phone 224-795-3521
Mailing address
1033 E Talbot StArlington Heights, IL 60004-5072
Phone 224-795-3521
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