MIRA A EBALO Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006738

License Status

ACTIVE

Business

First Name

MIRA

Middle

Last Name

EBALO

Business Name

MIRA A EBALO

Original Issue Date

08/29/2018

Effective Date

01/11/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60641

County

COOK

Ever Disciplined

LastModifiedDate

01/11/2026