{
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"FirstLineMailingAddress": "17 W GRAND AVE",
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"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-222-5610",
"MailingAddressFaxNumber": "312-661-1771",
"FirstLinePracticeLocationAddress": "17 W GRAND AVE",
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"PracticeLocationAddressCityName": "CHICAGO",
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"PracticeLocationAddressTelephoneNumber": "312-222-5610",
"PracticeLocationAddressFaxNumber": "312-661-1771",
"EnumerationDate": "06/30/2008",
"LastUpdateDate": "08/05/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAFARI",
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"AuthorizedOfficialCredential": "M.B.A.",
"AuthorizedOfficialTelephoneNumber": "312-222-5610",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "7003133",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}