{
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"FirstLineMailingAddress": "2357 SEQUOIA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AURORA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60506-6222",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-859-6800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2040 OGDEN AVE",
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"PracticeLocationAddressTelephoneNumber": "630-585-7100",
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"EnumerationDate": "11/14/2015",
"LastUpdateDate": "08/30/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NELSON",
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"AuthorizedOfficialTitle": "EVP FINANCIAL OPS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "414-299-1610",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}