Individual
MIRA AKBAR EBALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
9000 WAUKEGAN RD STE 210, MORTON GROVE, IL 60053-2127
(847) 967-5122
Mailing address
4157 N CLARENDON AVE APT 512, CHICAGO, IL 60613-2249
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006738
IL
363AM0700X
Medical Physician Assistant
085.006738
IL
363AS0400X
Surgical Physician Assistant
085.006738
IL
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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