{
"Npi": {
"NPI": "1659517076",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ARELIS M. MADERA, MD, PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3611 TAMIAMI TRL",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "PORT CHARLOTTE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33952-5528",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-235-0542",
"MailingAddressFaxNumber": "941-235-0545",
"FirstLinePracticeLocationAddress": "3611 TAMIAMI TRL",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "PORT CHARLOTTE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33952-5528",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-235-0542",
"PracticeLocationAddressFaxNumber": "941-235-0545",
"EnumerationDate": "01/07/2009",
"LastUpdateDate": "01/07/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MADERA",
"AuthorizedOfficialFirstName": "ARELIS",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "941-235-0542",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "ME74893",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}