# IOWA DERMATOLOGY INSTITUTE, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265636708
- **Authorized official:** DR. CARL W. SODERSTROM M.D. (PHYSICIAN)
- **Authorized official phone:** (309) 674-7546

## Contact information

- **Practice address:** 2315 ROOSEVELT ST, CLINTON, IA 52732-2412
- **Practice address phone:** (563) 242-3571
- **Practice address fax:** (563) 243-4971
- **Mailing address:** 4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
- **Mailing address phone:** (309) 674-7546
- **Mailing address fax:** (309) 282-0500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | NULL | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | — | — |
| 207ND0900X | Dermatopathology Physician | — | NULL | — |
| 207ND0900X | Dermatopathology Physician | — | — | — |
| 207NS0135X | Procedural Dermatology Physician | — | NULL | — |
| 207NS0135X | Procedural Dermatology Physician | — | — | — |
| 208200000X | Plastic Surgery Physician | — | NULL | — |
| 208200000X | Plastic Surgery Physician | — | — | — |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | — | NULL | — |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | — | — | — |
| 2082S0105X | Surgery of the Hand (Plastic Surgery) Physician | — | NULL | Yes |
| 2082S0105X | Surgery of the Hand (Plastic Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/11/2007
- **Last updated:** 09/11/2025