{
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"FirstLineMailingAddress": "718 E NORTHWEST HWY",
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"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "718 E NORTHWEST HWY",
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"PracticeLocationAddressCityName": "MOUNT PROSPECT",
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"EnumerationDate": "10/17/2022",
"LastUpdateDate": "10/27/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SANGOBANWO",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}