{
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"LastName": null,
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"FirstLineMailingAddress": "PO BOX 1866",
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"FirstLinePracticeLocationAddress": "5895 S BRAESWOOD BLVD",
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"EnumerationDate": "02/13/2015",
"LastUpdateDate": "02/13/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIZERSKY",
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"AuthorizedOfficialCredential": "D.O.",
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"Taxonomies": {
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"LicenseNumber": "Q0918",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}