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1437638574 NPI number — IMAGINEMD

NPI Number: 1437638574
Health Care Provider/Practitioner: IMAGINEMD

Information about “1437638574” NPI (IMAGINEMD) exists in 1437638574 in HTML format HTML  |  1437638574 in plain Text format TXT  |  1437638574 in PDF (Portable Document Format) PDF  |  1437638574 in an XML format XML  formats.

NPI Number : 1437638574 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437638574",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IMAGINEMD",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 652",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEMSON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29633-0652",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-364-0478",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10 S RIVERSIDE PLZ STE 2225",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60606-3707",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-374-5860",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/09/2018",
    "LastUpdateDate": "08/09/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LICKERMAN",
    "AuthorizedOfficialFirstName": "ALEX",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "312-374-5860",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "039.090525",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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