{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "2201 S HALSTED ST",
"SecondLineMailingAddress": "SUITE 1252",
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60608-4585",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
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"FirstLinePracticeLocationAddress": "12741 S SAGINAW ST",
"SecondLinePracticeLocationAddress": "OFFICE SUITE LL2",
"PracticeLocationAddressCityName": "GRAND BLANC",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-226-9989",
"PracticeLocationAddressFaxNumber": "312-416-9979",
"EnumerationDate": "01/28/2010",
"LastUpdateDate": "01/28/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOOD",
"AuthorizedOfficialFirstName": "GREG",
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"AuthorizedOfficialTitle": "MANAGING MEMBER",
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"AuthorizedOfficialTelephoneNumber": "312-226-9989",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "203.000989",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}