Carl William Soderstrom Jr., M.D.

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

Practice address

4909 N Glen Park Place Rd
Peoria, IL 61614-4676

Phone

(309) 674-7546

NPI assigned

Mar 21, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Iowa Dermatology Institute, P.C.

  • Surgery of the Hand (Plastic Surgery) Physician
  • Clinton, IA
  • NPI 1265636708
  Authorized official Same address or phone
• Robert G German MD PC

  dba Iowa Dermatology Institute

  • Dermatology Physician
  • Clinton, IA
  • NPI 1568656999
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1053370759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERSTROM",
        "first_name": "CARL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa E. Snyder, MD
• Terrah Marie Snyder
• Tea Marie Soberano, OTD, OTR/L
• Soderstrom Dermatology Center S C (Peoria Ambulatory Surgery Center)
• Soderstrom Dermatology Center S C
• John R Soderstrom, P.A.
• Christina D Soens, P. T.
• Anushree Solanki
• Zoe Louise Solomon
• Solvera Health PLLC

• Dermatopathology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Dermatopathology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.