{
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"FirstLineMailingAddress": "297 W THISTLE RD",
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"MailingAddressStateName": "IN",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "297 W THISTLE RD",
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"EnumerationDate": "04/28/2026",
"LastUpdateDate": "04/28/2026",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HEINOLD",
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"AuthorizedOfficialTelephoneNumber": "219-353-2273",
"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}