Healthcare Provider Details

I. General information

NPI: 1861300386
Provider Name (Legal Business Name): STENSTROM DERMATOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 N MULFORD RD STE 205
ROCKFORD IL
61107-3879
US

IV. Provider business mailing address

1235 N MULFORD RD STE 205
ROCKFORD IL
61107-3879
US

V. Phone/Fax

Practice location:
  • Phone: 815-484-9900
  • Fax: 815-487-4949
Mailing address:
  • Phone: 815-484-9900
  • Fax: 815-487-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA STENSTROM
Title or Position: PRESIDENT
Credential: MD
Phone: 815-520-0473