{
"Npi": {
"NPI": "1013185966",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ORTHOPEDIC TRAUMA SPECIALISTS PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 737",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARMINGTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48332-0737",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-697-9839",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "25500 MEADOWBROOK RD",
"SecondLinePracticeLocationAddress": "SUITE 275",
"PracticeLocationAddressCityName": "NOVI",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48375-1878",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-381-5778",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/13/2008",
"LastUpdateDate": "03/30/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COLEN",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "248-697-9839",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207XX0801X",
"TaxonomyName": "Orthopaedic Trauma Physician",
"LicenseNumber": "012323",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}