{
"Npi": {
"NPI": "1518903665",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AJJAMPORE",
"FirstName": "KALPANA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DIXIT-AJJAMPORE",
"OtherFirstName": "KALPANA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "4425 N PORT WASHINGTON RD",
"SecondLineMailingAddress": "ATTN: CSMCP CLINIC CREDENTIALING",
"MailingAddressCityName": "GLENDALE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53212-1082",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-773-6300",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2727 N MAYFAIR RD",
"SecondLinePracticeLocationAddress": "SUITE I",
"PracticeLocationAddressCityName": "WAUWATOSA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53222-4400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-773-6300",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/20/2006",
"LastUpdateDate": "05/24/2011",
"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": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "38369",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}