Iowa Dermatology Institute, P.C.

Primary specialty

Surgery of the Hand (Plastic Surgery) PhysicianTaxonomy code 2082S0105X

Legal business name

IOWA DERMATOLOGY INSTITUTE, P.C.

Practice address

2315 Roosevelt St
Clinton, IA 52732-2412

Phone

(563) 242-3571

Fax

(563) 243-4971

NPI assigned

Jun 11, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carl W. Soderstrom, M.D.NPI 1053370759

Title

Physician

Phone

(309) 674-7546

Specialties & licenses 7

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carl William Soderstrom Jr., M.D.

  • Dermatopathology Physician
  • Peoria, IL
  • NPI 1053370759
  Authorized official Same address or phone

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1265636708",
    "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",
            "fax_number": "309-282-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 ROOSEVELT ST",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527322412",
            "telephone_number": "563-242-3571",
            "fax_number": "563-243-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IOWA DERMATOLOGY INSTITUTE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SODERSTROM",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "309-674-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery of the Hand (Plastic Surgery) Physician in Clinton, IA
• Providers in Clinton, IA by specialty
• Surgery of the Hand (Plastic Surgery) Physician in Iowa

• 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.