Healthcare Provider Details

I. General information

NPI: 1346686912
Provider Name (Legal Business Name): LENI ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVENUE DESLOGE TOWER, 13TH FLOOR
ST. LOUIS MO
63110
US

IV. Provider business mailing address

3635 VISTA AVENUE DESLOGE TOWER, 13TH FLOOR
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-7992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2017013690
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30096
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: