Provider Demographics
NPI:1366422115
Name:TORGRUDE, ERICA L (DPM)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:L
Last Name:TORGRUDE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2103
Mailing Address - Country:US
Mailing Address - Phone:314-961-3113
Mailing Address - Fax:314-968-7529
Practice Address - Street 1:7509 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2103
Practice Address - Country:US
Practice Address - Phone:314-961-3113
Practice Address - Fax:314-968-7529
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018707213EP1101X, 213E00000X
IL016-005149213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5031010OtherMEDICARE NUMBER
ILK05131Medicare PIN
IL761790Medicare ID - Type UnspecifiedPROVIDER ID #