Individual provider · Type 1 NPI

Kelly Dietrick

Physician Assistant · Chicago, IL

NPI number 1265393003 Active

Practice location

6140 N Broadway St
Chicago, IL 60660-2538

Call (224) 795-3521 Map

Mailing address

1033 E Talbot St
Arlington Heights, IL 60004-5072

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X085-011805 (IL)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1265393003

Kelly Dietrick's National Provider Identifier is 1265393003, issued on Nov 20, 2025. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Chicago, IL. The record was last updated on Nov 20, 2025.