{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MARCO A JARAVA MD SC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "848 N ASHLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60622-5147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-421-1701",
"MailingAddressFaxNumber": "312-421-1702",
"FirstLinePracticeLocationAddress": "848 N ASHLAND AVE",
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"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-421-1701",
"PracticeLocationAddressFaxNumber": "312-421-1702",
"EnumerationDate": "03/07/2008",
"LastUpdateDate": "03/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JARAVA",
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"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "312-421-1701",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}