{
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"IsOrgSubpart": "Y",
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"FirstLineMailingAddress": "4760 PRESTON RD",
"SecondLineMailingAddress": "STE 244-244",
"MailingAddressCityName": "FRISCO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75034-8548",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-830-7768",
"MailingAddressFaxNumber": "940-387-9924",
"FirstLinePracticeLocationAddress": "2210 SAN JACINTO BLVD",
"SecondLinePracticeLocationAddress": "SUITE 4",
"PracticeLocationAddressCityName": "DENTON",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-830-7768",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/26/2016",
"LastUpdateDate": "10/06/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIDDHAPPAN",
"AuthorizedOfficialFirstName": "MURUGESAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "M.D",
"AuthorizedOfficialTelephoneNumber": "425-830-7768",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "N1756",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}