Provider profile · NPI 1922295328
Advanced Facial Plastics & Mohs
Dermatology, MOHS-Micrographic Surgery · Rockford, IL · NPI 1922295328 · No federal exclusion match
✔ Verified against the public CMS NPPES registry & HHS-OIG LEIE as of Jun 21, 2026. Source-linked, daily-refreshed. Public data only — no PHI.
Registry details
Type
Organization
Primary specialty
Dermatology, MOHS-Micrographic Surgery
Enumerated
Sep 28, 2007
License(s)
036104814 (IL), 036104814 (IL), 036104814 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1235 N MULFORD RD SUITE 100 | Rockford, IL 61107-3879 | 815-484-9900 |
| LOCATION | 1235 N MULFORD RD SUITE 100 | Rockford, IL 61107-3879 | 815-484-9900 |
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