{
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"OrgName": "EDGEBROOK FOOT & ANKLE CLINIC, INC",
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "5330 W DEVON AVE",
"SecondLineMailingAddress": "SUITE 10",
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60646-4148",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-792-9300",
"MailingAddressFaxNumber": "773-792-9302",
"FirstLinePracticeLocationAddress": "5330 W DEVON AVE",
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"PracticeLocationAddressCityName": "CHICAGO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-792-9300",
"PracticeLocationAddressFaxNumber": "773-792-9302",
"EnumerationDate": "05/26/2009",
"LastUpdateDate": "06/08/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
"AuthorizedOfficialFirstName": "PRATIBHA",
"AuthorizedOfficialMiddleName": "B",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "773-792-9300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "016.005386",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}