Individual
KELLY DIETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6140 N BROADWAY ST, CHICAGO, IL 60660-2538
(224) 795-3521
Mailing address
1033 E TALBOT ST, ARLINGTON HEIGHTS, IL 60004-5072
(224) 795-3521
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-011805
IL
Other
Enumeration date
11/20/2025
Last updated
11/20/2025
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