Provider Demographics
NPI:1376284505
Name:LUNDBERG, TORRIN CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:TORRIN
Middle Name:CHARLES
Last Name:LUNDBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:211 E BUTLER RD STE A2
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2170
Mailing Address - Country:US
Mailing Address - Phone:864-281-9171
Mailing Address - Fax:978-327-7938
Practice Address - Street 1:211 E BUTLER RD STE A2
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2170
Practice Address - Country:US
Practice Address - Phone:864-281-9171
Practice Address - Fax:978-327-7938
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC784213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD06633781OtherDRIVER'S LICENSE