MEDICARE: AGATA GEBALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1033069869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGATA GEBALA

Provider Business Mailing Address
First Line	:	2 W PEBBLE CT APT A
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-3298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 N WALL ST
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-3483
Country	:	US
Telephone Number	:	815-933-1671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	01/31/2026

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Directions to “ AGATA GEBALA ” Practice Location

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