{
"Npi": {
"NPI": "1649216045",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BREHM",
"FirstName": "JODI",
"MiddleName": "L",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GROSSMAN",
"OtherFirstName": "JODI",
"OtherMiddleName": "L",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "10400 75TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KENOSHA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53142-7884",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-648-5600",
"MailingAddressFaxNumber": "262-948-5735",
"FirstLinePracticeLocationAddress": "10400 75TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KENOSHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53142",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-648-5600",
"PracticeLocationAddressFaxNumber": "262-948-5735",
"EnumerationDate": "06/22/2006",
"LastUpdateDate": "11/24/2021",
"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": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "036112238",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "52096",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}