Soderstrom Dermatology Center S C in Peoria, IL

This location of Soderstrom Dermatology Center S C bills under NPI 1053362343, an organization record issued on May 12, 2006 with the primary taxonomy Ambulatory Surgical Clinic/Center. It is one of 2 NPIs registered under this name and one of 2 in Peoria; each clinician who sees you there has their own NPI and license.

CMS NPPES registry, file of Aug 9, 2026 · method · Verify with CMS →

Organization recordNPPES, Aug 2026

1053362343

Legal name: Soderstrom Dermatology Center S C
Entity: Type 2 · organization, a subpart
Parent organization: Soderstrom Dermatology Center S C
Primary taxonomy: Ambulatory Surgical Clinic/Center 261QA1903X
Practice location: 4909 N GLEN PARK PLACE RD, Peoria, IL 61614
Phone: 309-690-6012
Enumerated: May 12, 2006
Record updated: Jun 25, 2008
Authorized official: Executive Director, Soderstrom Derm (title as filed)

Public record from the NPPES NPI Registry (open it on CMS). An NPI identifies who bills; it is not a facility license.

The other Peoria NPI

Soderstrom Dermatology Center S C4909 N GLEN PARK PLACE RD · issued May 22, 20061710931670

11 clinicians CMS lists with Soderstrom Dermatology Center S C in Peoria

Ista Egbeto, MDDermatology Physician1962080754
Khaled El-Hoshy, MDDermatology Physician1831163377
Todd Gerlach, MDPlastic Surgery Physician1518046044
Michael Hayes, DODermatology Physician1912017245
Chad HoerrPhysician Assistant1689495152
Renata Jenkin, MDDermatology Physician1700848462
Jordyn Lewandowski, APRNFamily Nurse Practitioner1144892175
Karen Maloney, MDDermatology Physician1912918186
John Soderstrom, PAPhysician Assistant1871506931
Allison WangDermatology Physician1063953354
Taylor Wells, MDDermatology Physician1013596998

Source: CMS Doctors and Clinicians group affiliations, matched by practice name and city.

All 2 Soderstrom Dermatology Center S C NPIs

Every location registered under this name, in 1 city.

See every location

Checking an organization

Confirm the business with the Illinois secretary of state.
Check the HHS-OIG exclusion list for the organization.
Verify each clinician on their own record and the state license search.

Common questions

What does subpart mean?

The organization registered this NPI as a subpart: a part of the organization, such as a location, that bills under its own NPI.

Is an organization NPI a license?

No. An NPI identifies who bills. Facilities and the clinicians who work there are licensed separately by the state.

Which Peoria NPI should I use?

Ask the office which NPI it bills under; all 2 Peoria NPIs are registered under the same name.

Source: CMS National Plan and Provider Enumeration System (NPPES), monthly file of Aug 9, 2026 (NPPES files on CMS.gov). An NPI identifies who bills; it is not a license.