Individual
JOHN R SODERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
(309) 674-7546
Mailing address
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
(309) 674-7546
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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