Dr. Carl William Soderstrom JR.
Dermatologist Dermatopathologist
4909 N Glen Park Place Rd
Peoria
, Illinois 61614-4676
Dr. Carl William Soderstrom JR.
Dermatologist Dermatopathologist
4909 N Glen Park Place Rd
Peoria
, Illinois 61614-4676
(309) 674-7546
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About
Features
Specialties
- Dermatologist
- Dermatopathologist
Languages spoken
- English
Location
First Address
- Dr. Carl William Soderstrom JR.
- 4909 N Glen Park Place Rd
- Peoria, IL
- Zip : 61614-4676
- Phone : (309) 674-7546
Second Address
- Dr. Carl William Soderstrom JR.
- 4909 N Glen Park Place Rd
- Peoria, IL
- Zip : 61614-4676
- Phone : (309) 674-7546
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Is Dr. Carl William Soderstrom JR. a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207N00000X | Dermatologist | IL | |
| N | 207ND0900X | Dermatopathologist | IL |
National Provider Identifier
| NPI | 1053370759 |
|---|---|
| Provider Name | Dr. Carl William Soderstrom JR. |
| First Address | Peoria, IL 61614-4676 |
| Second Address | Peoria, IL 61614-4676 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/03/2006 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.