{
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"FirstLineMailingAddress": "706 PINTAIL CT",
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"FirstLinePracticeLocationAddress": "6211 N MILWAUKEE AVE",
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"PracticeLocationAddressFaxNumber": "773-631-4839",
"EnumerationDate": "11/19/2008",
"LastUpdateDate": "09/02/2009",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DZIK",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "773-255-5489",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": "070-006980",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}