Provider Demographics
NPI:1477745255
Name:STENSTROM, MELISSA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:STENSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1235 N MULFORD RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3879
Mailing Address - Country:US
Mailing Address - Phone:815-484-9900
Mailing Address - Fax:815-487-4949
Practice Address - Street 1:1235 N MULFORD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-484-9900
Practice Address - Fax:815-487-4949
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-126369207N00000X
WI51229-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400132372Medicare PIN