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

Kelly Dietrick

Individual provider Physician Assistant · NPI 1265393003

Kelly Dietrick is a Physician Assistant in Chicago, Illinois. Qualified in 2025, 1 year ago. Practices with Physicians Immediate Care North Chicago LLC, a 261-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
1
Licensed in
IL
In the registry since
2025
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

6140 N Broadway St
Chicago, IL 60660-2538
Phone: (224) 795-3521
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085-011805 (IL)

Record details

NPI number1265393003
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 20, 2025
Last updated in NPPESNovember 20, 2025
Certification dateNovember 20, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Physicians Immediate Care North Chicago Llc — 261 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Chicago