Individual
SHADI JIBAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20201 CRAWFORD AVE, OLYMPIA FIELDS, IL 60461-1010
(708) 679-2160
(708) 679-2161
Mailing address
6530 BELGIAN AVE, KALAMAZOO, MI 49009-8985
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
03614632
IL
207R00000X
Internal Medicine Physician
036146320
IL
207R00000X
Internal Medicine Physician
4301092393
MI
208M00000X
Hospitalist Physician
03614632
IL
208M00000X
Hospitalist Physician
Primary
036146320
IL
390200000X
Student in an Organized Health Care Education/Training Program
4301092393
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417961137
BCBSM - BRONSON
MI
05
—
1568622686
—
MI
Enumeration date
06/12/2008
Last updated
06/21/2023
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