Healthcare Provider Details

I. General information

NPI: 1710561634
Provider Name (Legal Business Name): DALE ZACHARY SALIO-AN GOZUM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E BROAD ST
ELYRIA OH
44035-6474
US

IV. Provider business mailing address

3600 FORBES AVENUE FORBES TOWER- PLAZA LEVEL SUITE 140
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number34-018779
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: