{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MICHELLE R BONNESS, M.D. S.C.",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "20611 WATERTOWN RD",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "WAUKESHA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53186-1871",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-782-7021",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "20611 WATERTOWN RD",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "WAUKESHA",
"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-782-7021",
"PracticeLocationAddressFaxNumber": "262-782-8738",
"EnumerationDate": "12/28/2007",
"LastUpdateDate": "01/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "QUIRK",
"AuthorizedOfficialFirstName": "JULIE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRACTICE MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "262-782-7021",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}