Healthcare Provider Details

I. General information

NPI: 1033069869
Provider Name (Legal Business Name): AGATA GEBALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 01/31/2026
Certification Date: 01/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST
KANKAKEE IL
60901-3483
US

IV. Provider business mailing address

2 W PEBBLE CT APT A
PALOS HILLS IL
60465-3298
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-1671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: