{
"Npi": {
"NPI": "1114152543",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WALTER",
"FirstName": "ADAM",
"MiddleName": "C",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2105 HAWTHORNE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OTTAWA HILLS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43606-2644",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-287-9238",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5308 HARROUN RD",
"SecondLinePracticeLocationAddress": "SUITE 280",
"PracticeLocationAddressCityName": "SYLVANIA",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43560-2193",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-824-1785",
"PracticeLocationAddressFaxNumber": "419-824-5953",
"EnumerationDate": "05/29/2009",
"LastUpdateDate": "10/21/2024",
"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": "207VX0201X",
"TaxonomyName": "Gynecologic Oncology Physician",
"LicenseNumber": "35129292",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}