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General NPI Number Information
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NPI Number | 1770016636
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE MENILLO D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 25 MICHIGAN ST NE STE 4200
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2559
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Country | US
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Telephone | 616-267-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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Fax | 313-876-1305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5101026148
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 5101026148
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License Number State | MI
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