{
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"FirstLineMailingAddress": "26645 W 12 MILE RD STE 208",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-281-4151",
"MailingAddressFaxNumber": "248-281-4151",
"FirstLinePracticeLocationAddress": "26645 W 12 MILE RD STE 208",
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"PracticeLocationAddressCityName": "SOUTHFIELD",
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"PracticeLocationAddressTelephoneNumber": "248-281-4082",
"PracticeLocationAddressFaxNumber": "248-281-4151",
"EnumerationDate": "04/26/2012",
"LastUpdateDate": "02/26/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAXIMORE",
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"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "248-205-7204",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}