Individual
KATELYN MIRABITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 E LAKE ST, HANOVER PARK, IL 60133-4869
(847) 472-1500
Mailing address
1515 E LAKE ST, HANOVER PARK, IL 60133-4869
(847) 472-1500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006610
IL
363A00000X
Physician Assistant
10002952A
IN
363A00000X
Physician Assistant
PA6276
MA
Other
Enumeration date
09/21/2017
Last updated
04/01/2021
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