{
"Npi": {
"NPI": "1689857955",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KIM D FJELSTAD DPM PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "14000 NICOLLET AVE",
"SecondLineMailingAddress": "306",
"MailingAddressCityName": "BURNSVILLE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55337-5790",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-435-2629",
"MailingAddressFaxNumber": "952-435-2650",
"FirstLinePracticeLocationAddress": "14000 NICOLLET AVE",
"SecondLinePracticeLocationAddress": "306",
"PracticeLocationAddressCityName": "BURNSVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55337-5790",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-435-2629",
"PracticeLocationAddressFaxNumber": "952-435-2650",
"EnumerationDate": "12/10/2007",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FJELSTAD",
"AuthorizedOfficialFirstName": "KIM",
"AuthorizedOfficialMiddleName": "DARYL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "952-435-2629",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "410",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}