{
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"FirstLineMailingAddress": "44555 WOODWARD AVE",
"SecondLineMailingAddress": "SUITE 404",
"MailingAddressCityName": "PONTIAC",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48341-5031",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-334-3460",
"MailingAddressFaxNumber": "248-334-0574",
"FirstLinePracticeLocationAddress": "44555 WOODWARD AVE",
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"PracticeLocationAddressTelephoneNumber": "248-334-3460",
"PracticeLocationAddressFaxNumber": "248-334-0574",
"EnumerationDate": "10/13/2010",
"LastUpdateDate": "10/13/2010",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WINKELMAN",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "248-334-3460",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "4301029593",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}