Individual
ANTOINE DAWALIBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6831 N PEARTREE LN, PEORIA, IL 61615-2400
(309) 691-1250
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360962372
—
IL
01
—
040290
HEALTH ALLIANCE
IL
01
—
472311
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
IL01B5
JOHN DEERE
IL
Enumeration date
07/27/2006
Last updated
07/08/2007
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