DR. CARL WILLIAM SODERSTROM JR. (NPI# 1053370759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053370759 |
| Entity Type | Individual |
| Full Name | DR. CARL WILLIAM SODERSTROM JR. |
| Credential | M.D. |
| Practice Address |
4909 N Glen Park Place Rd Peoria IL 61614-4676 |
| Practice Telephone | 3096747546 |
| Mailing Telephone | 3096747546 |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207N00000X | Dermatology | IL | Allopathic & Osteopathic Physicians | |
| X | 207ND0900X |
Dermatology Specialization: Dermatopathology |
IL | Allopathic & Osteopathic Physicians |
| Street Address |
4909 N GLEN PARK PLACE RD |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-4676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174599260 | Chen Wang | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-02-27 |
| 1790180164 | Sara Snarr | Nurse Practitioner | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2014-10-28 |
| 1700209160 | Sarah Christensen | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2014-01-21 |
| 1134481054 | Nour Almardini | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4689 | 2012-06-15 |
| 1922313238 | Stephanie M Ellis | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2010-08-11 |
| 1245490382 | Tesfu Hailu | Dermatology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2008-06-12 |
| 1477743813 | Michelle L Roth | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2007-08-01 |
| 1073655676 | James Murray Jeffries IIi | Surgery | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2007-02-12 |
| 1912017245 | Michael L Hayes | Dermatology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-08-30 |
| 1871506931 | John R Soderstrom | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659667954 | Katherine Ann Beaudry | Dermatology | 5401 N Knoxville Ave Ste 115, Peoria, IL 61614-5095 | 2011-06-24 |
| 1366753865 | Douglas Heiner | Dermatology | 14155 N 83rd Ave Ste 110, Peoria, AZ 85381-5640 | 2010-06-30 |
| 1902096928 | Joshua Bradley Kentosh | Dermatology | 4909 N. Glen Park Place, Peoria, IL 61614-4676 | 2007-07-26 |
| 1336341650 | Julie Diane Jacobs | Dermatology | 7767 W Deer Valley Road, Peoria, AZ 85382 | 2007-05-31 |
| 1457465858 | Epiphany Dermatology of Arizona, LLC | Dermatology | 7767 W Deer Valley Rd, Suite 140, Peoria, AZ 85382-2103 | 2006-08-19 |
| 1902852320 | Keith J Haar | Dermatology | 7767 W. Deer Valley Rd, Peoria, AZ 85382-2103 | 2006-05-26 |
| 1184600884 | North Valley Dermatology LLC | Dermatology | 14155 N 83rd Ave, Suite 110, Peoria, AZ 85381-5639 | 2005-12-15 |
| 1407830805 | Rosemary Theresa Depaoli | Dermatology | 7767 W Deer Valley Rd Ste 140, Peoria, AZ 85382-2103 | 2005-11-30 |
| 1548806276 | Arizona Mobile Dermatology and Wound Care Plc | Dermatology | 7615 W Thunderbird Rd Ste 105, Peoria, AZ 85381-6083 | 2019-11-18 |
| 1942681655 | Rachel Lauren Cetta | Dermatology | 14155 N 83rd Ave Ste 110, Peoria, AZ 85381-5640 | 2015-06-18 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.