{
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"FirstLineMailingAddress": "533 W NORTH AVE",
"SecondLineMailingAddress": "STE 206",
"MailingAddressCityName": "ELMHURST",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60126-2135",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-279-3222",
"MailingAddressFaxNumber": "630-279-3230",
"FirstLinePracticeLocationAddress": "533 W NORTH AVE",
"SecondLinePracticeLocationAddress": "STE 206",
"PracticeLocationAddressCityName": "ELMHURST",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-279-3222",
"PracticeLocationAddressFaxNumber": "630-279-3230",
"EnumerationDate": "05/07/2009",
"LastUpdateDate": "07/13/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KECALA",
"AuthorizedOfficialFirstName": "ZENON",
"AuthorizedOfficialMiddleName": "L",
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"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "036067696",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}