{
"Npi": {
"NPI": "1083983498",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KIDNEY CENTER OF MICHIGAN",
"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 71026",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCHESTER HILLS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48307-0019",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-858-3011",
"MailingAddressFaxNumber": "800-414-1646",
"FirstLinePracticeLocationAddress": "44555 WOODWARD AVE",
"SecondLinePracticeLocationAddress": "SUITE 404",
"PracticeLocationAddressCityName": "PONTIAC",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48341-5031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-858-3011",
"PracticeLocationAddressFaxNumber": "800-414-1646",
"EnumerationDate": "12/14/2011",
"LastUpdateDate": "02/24/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KAKULAVARAM",
"AuthorizedOfficialFirstName": "AMITH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "248-858-3011",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "4301084121",
"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."
}
}
}
}