MEDICARE: MIA LEE GATES PA-C

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		IL

General Provider Information

NPI Number	:	1386561421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA LEE GATES PA-C

Provider Business Mailing Address
First Line	:	901 BIESTERFIELD RD STE 300
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-7324
Country	:	US
Telephone Number	:	312-615-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 BIESTERFIELD RD STE 300
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-7324
Country	:	US
Telephone Number	:	312-615-6666
Fax Number	:

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

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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