Healthcare Provider Details

I. General information

NPI: 1588305759
Provider Name (Legal Business Name): MIKALA RAE DASKALAKIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKALA RAE RUSSELL DO

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 4TH ST SW
MASON CITY IA
50401-2800
US

IV. Provider business mailing address

2108 37TH ST
DES MOINES IA
50310-4413
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-7000
  • Fax:
Mailing address:
  • Phone: 920-420-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number58.032618
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58.032618
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO-06980
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: