{
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"LastName": null,
"FirstName": null,
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"FirstLineMailingAddress": "27101 SCHOENHERR RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARREN",
"MailingAddressStateName": "MI",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "27101 SCHOENHERR RD",
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"PracticeLocationAddressTelephoneNumber": "586-744-0797",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/08/2011",
"LastUpdateDate": "02/08/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KHAN",
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"AuthorizedOfficialTitle": "ADMINISTRATOR",
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"AuthorizedOfficialCredential": "O.T.R",
"AuthorizedOfficialTelephoneNumber": "586-744-0797",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}