{
"Npi": {
"NPI": "1760771117",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MICHIGAN BRAIN & SPINE PHYSICIANS GROUP",
"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": "29355 NORTHWESTERN HWY",
"SecondLineMailingAddress": "SUITE 130",
"MailingAddressCityName": "SOUTHFIELD",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48034-1053",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-440-7101",
"MailingAddressFaxNumber": "248-223-9070",
"FirstLinePracticeLocationAddress": "29355 NORTHWESTERN HWY",
"SecondLinePracticeLocationAddress": "SUITE 130",
"PracticeLocationAddressCityName": "SOUTHFIELD",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48034-1053",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-440-7101",
"PracticeLocationAddressFaxNumber": "248-223-9070",
"EnumerationDate": "04/06/2011",
"LastUpdateDate": "02/24/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PILOTZADA",
"AuthorizedOfficialFirstName": "NASRIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BUSINESS MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "248-440-7101",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207T00000X",
"TaxonomyName": "Neurological Surgery Physician",
"LicenseNumber": "4301097955",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}