{
"Npi": {
"NPI": "1639113012",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHAH",
"FirstName": "MRUGESHKUMAR",
"MiddleName": "KANAIYALAL",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SHAH",
"OtherFirstName": "MIKE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "3420 FORESTBROOK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHARDSON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75082",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-278-7772",
"MailingAddressFaxNumber": "469-429-1052",
"FirstLinePracticeLocationAddress": "6957 W PLANO PKWY",
"SecondLinePracticeLocationAddress": "SUITE 2600",
"PracticeLocationAddressCityName": "PLANO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75093-1620",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-499-4266",
"PracticeLocationAddressFaxNumber": "972-591-4605",
"EnumerationDate": "06/15/2006",
"LastUpdateDate": "07/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2081P2900X",
"TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": "L6174",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}