{
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"FirstLineMailingAddress": "10096 HART AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTINGTON WOODS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48070-1126",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-655-0337",
"MailingAddressFaxNumber": "248-655-0339",
"FirstLinePracticeLocationAddress": "16001 W 9 MILE RD",
"SecondLinePracticeLocationAddress": "PROVIDENCE HOSPITAL",
"PracticeLocationAddressCityName": "SOUTHFIELD",
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"PracticeLocationAddressTelephoneNumber": "313-971-3698",
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"EnumerationDate": "07/26/2006",
"LastUpdateDate": "02/29/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTIN",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "734-792-0441",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "4301061359",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}