Provider Demographics
NPI:1467473793
Name:LABABIDI, DIMA SARRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMA
Middle Name:SARRAJ
Last Name:LABABIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIMA
Other - Middle Name:FAISAL
Other - Last Name:SARRAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1514 W KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1612
Mailing Address - Country:US
Mailing Address - Phone:309-645-2179
Mailing Address - Fax:
Practice Address - Street 1:700 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6352
Practice Address - Country:US
Practice Address - Phone:217-522-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine