Healthcare Provider Details

I. General information

NPI: 1396272357
Provider Name (Legal Business Name): SAI PRAMOD KRISHNA ALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 E POLSTON AVE
POST FALLS ID
83854-6245
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 208-457-4208
  • Fax: 208-457-4197
Mailing address:
  • Phone: 208-262-2300
  • Fax: 208-262-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61448450
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberM-17197
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: