Healthcare Provider Details

I. General information

NPI: 1568203263
Provider Name (Legal Business Name): GANI ABAZI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8913
  • Fax: 573-884-1070
Mailing address:
  • Phone: 573-882-8913
  • Fax: 573-884-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number1568203263
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: