Healthcare Provider Details

I. General information

NPI: 1972685295
Provider Name (Legal Business Name): ZANE SAALOUKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 LANDERBROOK DR STE 301
MAYFIELD HTS OH
44124-4071
US

IV. Provider business mailing address

24701 EUCLID AVE
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-446-9991
  • Fax: 440-446-9998
Mailing address:
  • Phone: 440-446-9991
  • Fax: 440-446-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35063259S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: