{
"Npi": {
"NPI": "1619028008",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LILLY WILEN M.D. A MEDICAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "17075 DEVONSHIRE ST",
"SecondLineMailingAddress": "SUITE 306",
"MailingAddressCityName": "NORTHRIDGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91325-1600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-831-3227",
"MailingAddressFaxNumber": "818-831-3447",
"FirstLinePracticeLocationAddress": "17075 DEVONSHIRE ST",
"SecondLinePracticeLocationAddress": "SUITE 306",
"PracticeLocationAddressCityName": "NORTHRIDGE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91325-1600",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-831-3228",
"PracticeLocationAddressFaxNumber": "818-831-3447",
"EnumerationDate": "01/15/2007",
"LastUpdateDate": "01/05/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILEN",
"AuthorizedOfficialFirstName": "LILLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "818-831-3227",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "A61876",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}