{
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"FirstLineMailingAddress": "5300 FAR HILLS AVE",
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"MailingAddressCityName": "DAYTON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45429-2381",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-436-4146",
"MailingAddressFaxNumber": "937-530-4083",
"FirstLinePracticeLocationAddress": "225 E DEERPATH STE 50",
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"PracticeLocationAddressCityName": "LAKE FOREST",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "04/27/2006",
"LastUpdateDate": "08/26/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIRKLAND",
"AuthorizedOfficialFirstName": "EUGENE",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "937-434-2351",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "036068947",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}