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

John R Soderstrom, PA

Individual provider Physician Assistant · NPI 1871506931

John R Soderstrom, PA is a Physician Assistant in Peoria, Illinois. Qualified in 2006, 20 years ago. Practices with Soderstrom Dermatology Center S C, a 33-clinician group and accepts Medicare assignment.

Years since qualifying
20
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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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

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1871506931
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 13, 2006
Last updated in NPPESJuly 8, 2007
Mailing address4909 N Glen Park Place Rd, Peoria, IL 61614-4676

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Soderstrom Dermatology Center S C — 33 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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