| NPI | 1265636708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL W. SODERSTROM Physician 309-674-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| 207NS0135X Dermatology Procedural Dermatology | |
| 208200000X Plastic Surgery | |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck | |
| 2082S0105X Plastic Surgery Surgery of the Hand | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2020-08-22 |