Provider Demographics
NPI:1265465132
Name:LEUTHARDT, ERIC CLAUDE (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CLAUDE
Last Name:LEUTHARDT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-3577
Mailing Address - Fax:314-362-2107
Practice Address - Street 1:4500 FOREST PARK AVE
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY, STE 1B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2114
Practice Address - Country:US
Practice Address - Phone:314-362-3577
Practice Address - Fax:314-362-2107
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003025131207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201717006Medicaid
MO960240253Medicare PIN
IL$$$$$$$$$Medicaid
MOP00398653Medicare PIN