Robert M Soderstrom, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301032434 Issued in MI

Practice address

G-5131 West Bristol Rd
Ste a
Flint, MI 48507

Phone

(810) 733-2090

Fax

(810) 733-0387

NPI assigned

Jul 10, 2006

Last updated

Jul 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Joliet, IL
  • NPI 1861930984

  MI

  Medicare reassignment
• Robert M Soderstrom MD PC

  • Dermatology Physician
  • Flint, MI
  • NPI 1043484421
  Authorized official Same address or phone
• Audrey Bruell, M.D. P.C.

  • Dermatology Physician
  • Livonia, MI
  • NPI 1306965983
  NPD

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1548294176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5131 W BRISTOL RD",
            "address_2": "STE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485072970",
            "telephone_number": "810-733-2090",
            "fax_number": "630-495-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "G-5131 WEST BRISTOL RD",
            "address_2": "STE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48507",
            "telephone_number": "810-733-2090",
            "fax_number": "810-733-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERSTROM",
        "first_name": "ROBERT",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301032434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK MICHIGA",
            "identifier": "0257159",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS OF MICHIGAN",
            "identifier": "0771592",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1421419",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Sobieray, LMT
• Jolanta Sobotka-Czarnecki, MD
• John R Socey, D.O.
• Barbara Socha, M.D.
• Cassandra Socia, RDH
• Julie Trang Sofer, D.O.
• Douglas Michael Sokol, LPN
• Solace Homecare Services
• Linda Irene Soltis, CRNA
• Nikki Somers-Klanseck

• Dermatology Physician in Flint, MI
• Providers in Flint, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.