Healthcare Provider Details

I. General information

NPI: 1649841255
Provider Name (Legal Business Name): ANEREE H DESAI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

IV. Provider business mailing address

P.O. BOX 4168
POCATELLO ID
83205-4168
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-2481
  • Fax: 208-239-3691
Mailing address:
  • Phone: 208-239-1035
  • Fax: 208-239-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD485019
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: