{
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"FirstLineMailingAddress": "4000 WELLNESS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDLAND",
"MailingAddressStateName": "MI",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-734-4254",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2402 BRADLEY HIGHWAY",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "ROGERS CITY",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/30/2007",
"LastUpdateDate": "09/09/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEPPERT",
"AuthorizedOfficialFirstName": "KENNETH",
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"AuthorizedOfficialCredential": "R.P.T.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Acute Care Hospital",
"LicenseNumber": "5501002011",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}