Individual
MS. KARINA J MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8321 W NORTH AVE, MELROSE PARK, IL 60160-1605
(708) 681-2298
(708) 681-2398
Mailing address
600 W FULTON ST STE 200, CHICAGO, IL 60661-1262
(312) 526-2083
(312) 526-2083
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-005705
IL
363AM0700X
Medical Physician Assistant
085.005705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.005705
PHYSICIAN ASSISTANT LICENSE
IL
Enumeration date
10/23/2015
Last updated
04/27/2021
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