Healthcare Provider Details

I. General information

NPI: 1043357452
Provider Name (Legal Business Name): ABRAM JOHN ELSENRAAT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

1316 OLD HIGHWAY 63 S SUITE 102
COLUMBIA MO
65201-6092
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax:
Mailing address:
  • Phone: 573-875-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2003022490
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2003022490
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2003022490
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: