Provider Demographics
NPI:1467978049
Name:MIRABITO, JON JAMES (PA-C)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:JAMES
Last Name:MIRABITO
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-3715
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:331-221-5809
Practice Address - Fax:331-221-3931
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2025-03-26
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Provider Licenses
StateLicense IDTaxonomies
IL085-006609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant