Healthcare Provider Details

I. General information

NPI: 1295296093
Provider Name (Legal Business Name): ANDREW SHIRALI GOLDBLUM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33355 HEALTH CAMPUS BLVD
AVON OH
44011-1399
US

IV. Provider business mailing address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-0489
  • Fax:
Mailing address:
  • Phone: 330-344-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34.017782
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34.017782
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.017782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: