{
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"FirstLineMailingAddress": "17680 SOUTH KEDZIE AVE",
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"MailingAddressPostalCode": "60429-2043",
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"MailingAddressTelephoneNumber": "708-206-2200",
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"FirstLinePracticeLocationAddress": "5320 159TH ST STE 100",
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"PracticeLocationAddressCityName": "OAK FOREST",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressFaxNumber": "708-991-7247",
"EnumerationDate": "10/22/2019",
"LastUpdateDate": "01/08/2024",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAWAT",
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"AuthorizedOfficialTitle": "AGENCY MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
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"AuthorizedOfficialTelephoneNumber": "708-206-2200",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251E00000X",
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}