{
"Npi": {
"NPI": "1629174024",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PANCHAL",
"FirstName": "SUJAL",
"MiddleName": "V",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FADIA",
"OtherFirstName": "SUJAL",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "100 BATSON CT",
"SecondLineMailingAddress": "SUITE 106",
"MailingAddressCityName": "NEW LENOX",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60451-1564",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-463-9747",
"MailingAddressFaxNumber": "815-463-9749",
"FirstLinePracticeLocationAddress": "100 BATSON CT",
"SecondLinePracticeLocationAddress": "SUITE 106",
"PracticeLocationAddressCityName": "NEW LENOX",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60451-1564",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-463-9747",
"PracticeLocationAddressFaxNumber": "815-463-9749",
"EnumerationDate": "09/15/2006",
"LastUpdateDate": "10/19/2020",
"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": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "036119020",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "A82152",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "4301106399",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}