Soderstrom Dermatology Center S C
Soderstrom Dermatology Center S C is a healthcare organization registered as Dermatology Physician in Peoria, IL, holding Type 2 (organization) NPI 1710931670 since 2006. The authorized official on file is Christina Peugh, Executive Director.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1710931670 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Soderstrom Dermatology Center S C |
| Practice address | 4909 N GLEN PARK PLACE RD, Peoria, IL, 61614 |
| Phone | 3096747546 |
| Enumeration date | 2006-05-22 |
| Last updated in NPPES | 2008-04-08 |
Authorized official
| Name | Christina Peugh |
|---|---|
| Title | Executive Director |
| Phone | 3096747546 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 207ZD0900X | Dermatopathology (Pathology) Physician | Secondary | — | — |
| 208200000X | Plastic Surgery Physician | Secondary | — | — |
| 208600000X | Surgery Physician | Secondary | — | — |
| 207ND0900X | Dermatopathology Physician | Secondary | — | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | Secondary | — | — |
| 207NS0135X | Procedural Dermatology Physician | Secondary | — | — |
| 207N00000X | Dermatology Physician | Primary | — | — |
Copy-ready billing details
Provider: Soderstrom Dermatology Center S C NPI: 1710931670 Taxonomy: 207N00000X (Dermatology Physician) Address: 4909 N GLEN PARK PLACE RD, Peoria, IL, 61614
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1417923517 | John Lomax | Individual | Plastic Surgery Physician | Peoria, IL |
| 1053370759 | Carl Soderstrom | Individual | Dermatopathology Physician | Peoria, IL |
| 1093774705 | Stuart Berryman | Individual | Medical Physician Assistant | Peoria, IL |
| 1053362343 | Soderstrom Dermatology Center S C | Organization | Ambulatory Surgical Clinic/Center | Peoria, IL |
| 1871506931 | John Soderstrom | Individual | Physician Assistant | Peoria, IL |
| 1912017245 | Michael Hayes | Individual | Dermatology Physician | Peoria, IL |
| 1518046044 | Todd Gerlach | Individual | Plastic Surgery Physician | Peoria, IL |
| 1073655676 | James Jeffries | Individual | Plastic and Reconstructive Surgery Physician | Peoria, IL |
Verify this record
Cross-check NPI 1710931670 against the authoritative CMS record: view Soderstrom Dermatology Center S C on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Soderstrom Dermatology Center S C?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2008-04-08.