{
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"FirstLineMailingAddress": "395 N GROESBECK HWY",
"SecondLineMailingAddress": "SUITE L",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-630-0474",
"MailingAddressFaxNumber": "586-630-0476",
"FirstLinePracticeLocationAddress": "395 N GROESBECK HWY",
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"PracticeLocationAddressTelephoneNumber": "586-630-0474",
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"EnumerationDate": "11/03/2016",
"LastUpdateDate": "11/03/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATTIA",
"AuthorizedOfficialFirstName": "JULIAN",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "248-508-7550",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}