Provider Demographics
NPI:1467978049
Name:MIRABITO, JON JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:JAMES
Last Name:MIRABITO
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2363 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1369
Mailing Address - Country:US
Mailing Address - Phone:603-716-7510
Mailing Address - Fax:
Practice Address - Street 1:396 REMINGTON BLVD STE 240
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4307
Practice Address - Country:US
Practice Address - Phone:630-226-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2021-03-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant