{
"Npi": {
"NPI": "1598947996",
"EntityType": "Organization",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ELLEN A. JANETZKE, M.D., P.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "60 W BIG BEAVER RD STE 100NA",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLOOMFIELD HILLS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48304-3909",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-258-5100",
"MailingAddressFaxNumber": "248-258-5110",
"FirstLinePracticeLocationAddress": "60 W BIG BEAVER RD STE 100NA",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLOOMFIELD HILLS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48304-3909",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-258-5100",
"PracticeLocationAddressFaxNumber": "248-258-5110",
"EnumerationDate": "11/28/2007",
"LastUpdateDate": "05/26/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JANETZKE",
"AuthorizedOfficialFirstName": "ELLEN",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D",
"AuthorizedOfficialTelephoneNumber": "248-258-5100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "EJ066875",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}