MIRA A EBALO - Physician Assistant License in Illinois | # 085006738

MIRA A EBALO

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006738

License Status

ACTIVE

Business

N

First Name

MIRA

Middle

A

Last Name

EBALO

Business Name

MIRA A EBALO

Original Issue Date

08/29/2018

Effective Date

01/11/2026

Expiration Date

03/01/2028

State

IL

Ever Disciplined

N

LastModifiedDate

01/11/2026