{
"Npi": {
"NPI": "1336510072",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEPHRO-CARE MD PLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "23010 SHERIDAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DEARBORN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48128-1837",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-462-0340",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19141 GREENFIELD RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DETROIT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48235-6007",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "133-960-6605",
"PracticeLocationAddressFaxNumber": "734-753-9151",
"EnumerationDate": "10/07/2015",
"LastUpdateDate": "01/25/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAAD",
"AuthorizedOfficialFirstName": "CHADI",
"AuthorizedOfficialMiddleName": "YOUSSEF",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "313-608-8068",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "4301091025",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}