{
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"FirstLineMailingAddress": "13929 APACHE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORLAND PARK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60462-1869",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-444-4114",
"MailingAddressFaxNumber": "708-429-5950",
"FirstLinePracticeLocationAddress": "6307 S STEWART AVE STE 202",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60621-3116",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-444-4114",
"PracticeLocationAddressFaxNumber": "708-429-5950",
"EnumerationDate": "02/13/2008",
"LastUpdateDate": "05/12/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "GARY",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "708-444-4114",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0131X",
"TaxonomyName": "Foot Surgery Podiatrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}