Healthcare Provider Details

I. General information

NPI: 1053047258
Provider Name (Legal Business Name): DANA GHAZALEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 153RD ST
URBANDALE IA
50323-2423
US

IV. Provider business mailing address

3010 153RD ST
URBANDALE IA
50323-2423
US

V. Phone/Fax

Practice location:
  • Phone: 612-707-7682
  • Fax:
Mailing address:
  • Phone: 612-707-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD-56922
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: