MIRA A EBALO Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****96

License Status

ACTIVE

Business

First Name

MIRA

Middle

Last Name

EBALO

Business Name

MIRA A EBALO

Original Issue Date

12/04/2018

Effective Date

01/11/2026

Expiration Date

03/01/2028

City

MORTON GROVE

State

Zip

60053

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/11/2026