Provider Demographics
NPI:1588305759
Name:DASKALAKIS, MIKALA RAE (DO)
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:RAE
Last Name:DASKALAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIKALA
Other - Middle Name:RAE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2108 37TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-4413
Mailing Address - Country:US
Mailing Address - Phone:920-420-2358
Mailing Address - Fax:
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-428-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.032618208000000X, 390200000X
IADO-06980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program