{
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"FirstLineMailingAddress": "233 FULTON ST E",
"SecondLineMailingAddress": "SUITE 28",
"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49503-3200",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-458-6967",
"MailingAddressFaxNumber": "616-458-6991",
"FirstLinePracticeLocationAddress": "233 FULTON ST E",
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"PracticeLocationAddressCityName": "GRAND RAPIDS",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-458-6967",
"PracticeLocationAddressFaxNumber": "616-458-6991",
"EnumerationDate": "05/02/2006",
"LastUpdateDate": "05/15/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RASIKAS",
"AuthorizedOfficialFirstName": "KYLE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "616-458-6967",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Cardiovascular Disease Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}