{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "S72W13575 WOODS RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MUSKEGO",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53150-3707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-427-1577",
"MailingAddressFaxNumber": "414-427-1577",
"FirstLinePracticeLocationAddress": "15350 W NATIONAL AVE",
"SecondLinePracticeLocationAddress": "SUITE 212",
"PracticeLocationAddressCityName": "NEW BERLIN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-782-9541",
"PracticeLocationAddressFaxNumber": "262-782-6541",
"EnumerationDate": "07/26/2011",
"LastUpdateDate": "08/15/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOCOUREK",
"AuthorizedOfficialFirstName": "GENEVIE",
"AuthorizedOfficialMiddleName": "LOREE",
"AuthorizedOfficialTitle": "DIRECTOR/OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "414-427-1577",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "53754",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}