Healthcare Provider Details

I. General information

NPI: 1760294649
Provider Name (Legal Business Name): FITTER HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 DUNHAM RD STE 100
ST CHARLES IL
60174-1453
US

IV. Provider business mailing address

1114 LONDONBERRY LN
GLEN ELLYN IL
60137-6110
US

V. Phone/Fax

Practice location:
  • Phone: 630-765-0026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAWAD FITTER
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 630-765-0026