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1093121188 NPI number — MITCHELL LAKS

NPI Number: 1093121188
Health Care Provider/Practitioner: MITCHELL LAKS

Information about “1093121188” NPI (MITCHELL LAKS) exists in 1093121188 in HTML format HTML  |  1093121188 in plain Text format TXT  |  1093121188 in PDF (Portable Document Format) PDF  |  1093121188 in an XML format XML  formats.

NPI Number : 1093121188 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093121188",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LAKS",
    "FirstName": "MITCHELL",
    "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 2240",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BURLINGTON",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27216-2240",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2250 W CAMPBELL PARK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60612-3502",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-243-0600",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/09/2014",
    "LastUpdateDate": "07/09/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "246QL0901X",
        "TaxonomyName": "Diplomate Laboratory Management Specialist/Technologist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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