{
"Npi": {
"NPI": "1154219608",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE THINK TANK 3D",
"LastName": null,
"FirstName": null,
"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": "17101 ALBION ST STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DETROIT",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48234-3808",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-515-5380",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "17101 ALBION ST STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DETROIT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48234-3808",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-472-8661",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/24/2025",
"LastUpdateDate": "07/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NELSON",
"AuthorizedOfficialFirstName": "LERRLYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DR./OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD",
"AuthorizedOfficialTelephoneNumber": "313-515-5380",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208C00000X",
"TaxonomyName": "Colon & Rectal Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332000000X",
"TaxonomyName": "Military/U.S. Coast Guard Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332100000X",
"TaxonomyName": "Department of Veterans Affairs (VA) Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332800000X",
"TaxonomyName": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332900000X",
"TaxonomyName": "Non-Pharmacy Dispensing Site",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM1100X",
"TaxonomyName": "Military/U.S. Coast Guard Outpatient Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332BN1400X",
"TaxonomyName": "Nursing Facility Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "376K00000X",
"TaxonomyName": "Nurse's Aide",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}