Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Carl William Soderstrom Jr., MD

Individual provider Dermatology Physician · NPI 1053370759

Dr. Carl William Soderstrom Jr., MD is a Dermatology Physician in Peoria, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4909 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone: (309) 674-7546
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatopathology Physician (primary) Taxonomy 207ND0900X (IL)
Dermatology Physician Taxonomy 207N00000X (IL)

Record details

NPI number1053370759
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 21, 2006
Last updated in NPPESSeptember 11, 2025
Mailing address4909 N Glen Park Place Rd, Peoria, IL 61614-4676

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