Individual
VENUMADHAV RAYASAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 HOSPITAL WAY, SUITE 202, POCATELLO, ID 83201-5175
(208) 239-2640
(208) 239-3737
Mailing address
P.O. BOX 4168, POCATELLO, ID 83205-4168
(208) 239-1035
(208) 239-3626
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1561378
ID
207RP1001X
Pulmonary Disease Physician
Primary
1561378
ID
Other
Enumeration date
07/12/2019
Last updated
09/02/2025
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