Provider Demographics
NPI:1306414560
Name:WELCH, MIKAYLA ROSE (DO)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ROSE
Last Name:WELCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:ROSE
Other - Last Name:KNAEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:681 28TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5147
Mailing Address - Country:US
Mailing Address - Phone:573-690-6710
Mailing Address - Fax:515-241-4080
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-6636
Practice Address - Fax:515-241-4080
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-12147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine