Provider Demographics
NPI:1982618930
Name:DAWALIBI, ANTOINE (DO)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:DAWALIBI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:309-672-4809
Mailing Address - Fax:
Practice Address - Street 1:6831 N PEARTREE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2400
Practice Address - Country:US
Practice Address - Phone:309-691-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL01B5OtherJOHN DEERE
IL7215059OtherBCBS PPO
IL472311OtherHEALTHLINK
IL0360962372Medicaid
IL040290OtherHEALTH ALLIANCE
IL7215059OtherBCBS PPO
IL0360962372Medicaid