{
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"FirstLineMailingAddress": "PO BOX 6253",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAROL STREAM",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60197-6253",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-530-2988",
"MailingAddressFaxNumber": "630-832-9750",
"FirstLinePracticeLocationAddress": "39010 N CAROLINE AVE",
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"PracticeLocationAddressCityName": "WADSWORTH",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressTelephoneNumber": "847-336-1080",
"PracticeLocationAddressFaxNumber": "847-336-1097",
"EnumerationDate": "06/05/2006",
"LastUpdateDate": "09/08/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIRSCHHOFFER",
"AuthorizedOfficialFirstName": "MARK",
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"AuthorizedOfficialTitle": "FIRE CHIEF",
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"AuthorizedOfficialTelephoneNumber": "847-336-1080",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "7298",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}