{
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"FirstLineMailingAddress": "5174 ROYCE RD",
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"MailingAddressStateName": "MI",
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"FirstLinePracticeLocationAddress": "4830 CENTRAL PARK DR",
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"PracticeLocationAddressCityName": "OKEMOS",
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"EnumerationDate": "04/02/2020",
"LastUpdateDate": "04/02/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLAN",
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"AuthorizedOfficialMiddleName": "LAMONT",
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"AuthorizedOfficialCredential": "DO",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}