Basic Information
Provider Information
NPI: 1235521840
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANKO
FirstName: ALEXANDRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HAMELRATH
OtherFirstName: ALEXANDRA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PA-C
OtherLastNameType: 1
Mailing Information
Address1: 26901 BEAUMONT BLVD STE 3D
Address2:  
City: SOUTHFIELD
State: MI
PostalCode: 480333849
CountryCode: US
TelephoneNumber: 9475221952
FaxNumber: 9475220307
Practice Location
Address1: 44201 DEQUINDRE RD
Address2:  
City: TROY
State: MI
PostalCode: 480851117
CountryCode: US
TelephoneNumber: 2489645000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/19/2015
LastUpdateDate: 05/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X5601007296MIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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