{
"Npi": {
"NPI": "1386328391",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MACAK",
"FirstName": "MARK",
"MiddleName": "ANTHONY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10330 S 82ND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALOS HILLS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60465-1830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-420-3677",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5701 W MONEE MANHATTAN RD STE 109",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONEE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60449-8091",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-305-7678",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/12/2023",
"LastUpdateDate": "06/12/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "019034327",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "019034327",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}