{
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"FirstLineMailingAddress": "5500 MARYLAND WAY STE 120",
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"MailingAddressCityName": "BRENTWOOD",
"MailingAddressStateName": "TN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "123 E MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOUISVILLE",
"PracticeLocationAddressStateName": "KY",
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"PracticeLocationAddressTelephoneNumber": "502-476-2662",
"PracticeLocationAddressFaxNumber": "502-509-6976",
"EnumerationDate": "04/08/2021",
"LastUpdateDate": "08/15/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEIZMAN",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "216-479-9063",
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"Taxonomy": {
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"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}