NPI Code Detail JSON Logo

1720669880 NPI number — ENDOMETRIOSIS TREATMENT CENTER OF AMERICA - MICHIGAN PLLC

NPI Number: 1720669880
Health Care Provider/Practitioner: ENDOMETRIOSIS TREATMENT CENTER OF AMERICA - MICHIGAN PLLC

Information about “1720669880” NPI (ENDOMETRIOSIS TREATMENT CENTER OF AMERICA - MICHIGAN PLLC) exists in 1720669880 in HTML format HTML  |  1720669880 in plain Text format TXT  |  1720669880 in PDF (Portable Document Format) PDF  |  1720669880 in an XML format XML  formats.

NPI Number : 1720669880 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720669880",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ENDOMETRIOSIS TREATMENT CENTER OF AMERICA - MICHIGAN PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1430 S LAPEER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE ORION",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48360-1437",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-693-1630",
    "MailingAddressFaxNumber": "248-731-2156",
    "FirstLinePracticeLocationAddress": "1430 S LAPEER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE ORION",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48360-1437",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-693-1630",
    "PracticeLocationAddressFaxNumber": "248-731-2156",
    "EnumerationDate": "04/19/2021",
    "LastUpdateDate": "03/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ZAIDAN",
    "AuthorizedOfficialFirstName": "JONATHAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "248-693-1630",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207VF0040X",
          "TaxonomyName": "Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207VG0400X",
          "TaxonomyName": "Gynecology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207VX0201X",
          "TaxonomyName": "Gynecologic Oncology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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