{
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"NamePrefix": null,
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"FirstLineMailingAddress": "6813 167TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TINLEY PARK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60477-2501",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-532-7050",
"MailingAddressFaxNumber": "708-532-2676",
"FirstLinePracticeLocationAddress": "6813 167TH ST",
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"PracticeLocationAddressCityName": "TINLEY PARK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-532-7050",
"PracticeLocationAddressFaxNumber": "708-532-2676",
"EnumerationDate": "08/13/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HALPIN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "708-532-7050",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}