Provider Demographics
NPI:1053047258
Name:GHAZALEH, DANA (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GHAZALEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 REDTAIL BND APT 8
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-4023
Mailing Address - Country:US
Mailing Address - Phone:612-707-7682
Mailing Address - Fax:
Practice Address - Street 1:30 REDTAIL BND
Practice Address - Street 2:APT 8
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-4023
Practice Address - Country:US
Practice Address - Phone:612-707-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-124252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology