SODERSTROM DERMATOLOGY CENTER S C
NPI 1710931670
Dermatology in Peoria, IL

Active since May 22, 2006
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614(309) 674-7546 Get Directions Write a Review

NPPES record last updated: April 8, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Soderstrom Dermatology Center S C NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SODERSTROM DERMATOLOGY CENTER S C (NPI 1710931670) is a healthcare organization registered as a dermatology in Peoria, Illinois and active in the NPI registry since May 2006. The organization lists Christina M Peugh, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1710931670
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSODERSTROM DERMATOLOGY CENTER S C
Location Address4909 N GLEN PARK PLACE RDPeoria, IL 61614-4676
Mailing Address4909 N Glen Park Place RdPeoria, IL 61614-4676 · (309) 674-7546
Organization SubpartNo
Authorized OfficialChristina M PeughExecutive Director · (309) 674-7546
Enumeration DateMay 22, 2006
Last NPPES UpdateApril 8, 2008
NPI 1710931670 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
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.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
Also ListedPathology · DermatopathologyTaxonomy 207ZD0900X
Also ListedPlastic SurgeryTaxonomy 208200000X
Also ListedSurgeryTaxonomy 208600000X
4909 N GLEN PARK PLACE RD, Peoria, IL 61614

Other Identifiers 1

Medicare PIN460810IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dermatology
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Nurse Practitioner (Family)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Clinic/Center (Ambulatory Surgical)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Dermatology (Dermatopathology)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Surgery (Plastic and Reconstructive Surgery)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Physician Assistant (Medical)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Nurse Practitioner (Family)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614
Dermatology (Dermatopathology)
4909 N GLEN PARK PLACE RD
PEORIA, IL 61614

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Soderstrom Dermatology Center S C's NPI number?

The NPI number for Soderstrom Dermatology Center S C is 1710931670. It was assigned to this organization in the NPPES registry on May 22, 2006.

Where is Soderstrom Dermatology Center S C located?

Soderstrom Dermatology Center S C is located at 4909 N Glen Park Place Rd, Peoria, IL 61614. The listed phone number is (309) 674-7546.

What is Soderstrom Dermatology Center S C's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

What insurance does Soderstrom Dermatology Center S C accept?

Health plans from Medica list Soderstrom Dermatology Center S C as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Soderstrom Dermatology Center S C was last updated on April 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.