{
"Npi": {
"NPI": "1407351737",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EKKEL-AYOUB",
"FirstName": "ELISABETH",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DO",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "COMPREHENSIVE BREAST CARE",
"SecondLineMailingAddress": "5701 BOW POINTE DR., SUITE 280",
"MailingAddressCityName": "CLARKSTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48346",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-922-6635",
"MailingAddressFaxNumber": "248-922-6636",
"FirstLinePracticeLocationAddress": "COMPREHENSIVE BREAST CARE",
"SecondLinePracticeLocationAddress": "4967 CROOKS RD #210",
"PracticeLocationAddressCityName": "TROY",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48098",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-687-7300",
"PracticeLocationAddressFaxNumber": "248-687-7305",
"EnumerationDate": "03/28/2018",
"LastUpdateDate": "11/14/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2086X0206X",
"TaxonomyName": "Surgical Oncology Physician",
"LicenseNumber": "5101027297",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "5101027297",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}