=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265465132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC CLAUDE LEUTHARDT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 FOREST PARK AVE DEPT NEUROLOGICAL SURGERY, STE 1B
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-362-3577
-----------------------------------------------------
Fax | 314-362-2107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7412011
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60674-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-362-3577
-----------------------------------------------------
Fax | 314-362-2107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 2003025131
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------