{
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"OrgName": "MARIDEL HERNANDEZ INTERNAL MEDICINE PC",
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"FirstLineMailingAddress": "131 KERCHEVAL AVE",
"SecondLineMailingAddress": "SUITE 120",
"MailingAddressCityName": "GROSSE POINTE FARMS",
"MailingAddressStateName": "MI",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-640-8400",
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"FirstLinePracticeLocationAddress": "131 KERCHEVAL AVE",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "313-640-9232",
"EnumerationDate": "10/25/2006",
"LastUpdateDate": "01/12/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HERNANDEZ",
"AuthorizedOfficialFirstName": "MARIDEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER CEO",
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"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "313-640-8400",
"Taxonomies": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "5101012021",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}