{
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"FirstLineMailingAddress": "1876 NORTHWOOD PLAZA DR",
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"MailingAddressFaxNumber": "317-346-7722",
"FirstLinePracticeLocationAddress": "11725 N ILLINOIS ST STE 560",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "317-346-7725",
"EnumerationDate": "08/13/2007",
"LastUpdateDate": "08/13/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEHEER",
"AuthorizedOfficialFirstName": "PATRICK",
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"AuthorizedOfficialCredential": "DPM",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Podiatrist",
"LicenseNumber": "07000710",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}