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
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Practice location Address checks out

6140 N Broadway St
Chicago, IL 60660-2538
Phone: (224) 795-3521
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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
Mailing address1033 E Talbot St, Arlington Heights, IL 60004-5072

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

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