MEDICARE: DR. ERICA L TORGRUDE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	2004018707	MO
2	213E00000X	Podiatrist	2004018707	MO
3	213ES0103X	Foot & Ankle Surgery Podiatrist	016-005149	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA5031010	OTHER	MO	MEDICARE NUMBER

General Provider Information

NPI Number	:	1366422115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA L TORGRUDE DPM

Provider Business Mailing Address
First Line	:	7509 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2103
Country	:	US
Telephone Number	:	314-961-3113
Fax Number	:	314-968-7529

Provider Business Practice Location Address
First Line	:	7509 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2103
Country	:	US
Telephone Number	:	314-961-3113
Fax Number	:	314-968-7529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/14/2021

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