Healthcare Provider Details

I. General information

NPI: 1699510941
Provider Name (Legal Business Name): CHRISTINE LEE FATT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N RIVER RD STE 220
DES PLAINES IL
60016-1297
US

IV. Provider business mailing address

9400 S CICERO AVE STE 100
OAK LAWN IL
60453-2536
US

V. Phone/Fax

Practice location:
  • Phone: 847-487-2827
  • Fax: 847-487-2860
Mailing address:
  • Phone: 708-424-3201
  • Fax: 708-424-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010672
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: