Healthcare Provider Details

I. General information

NPI: 1851916217
Provider Name (Legal Business Name): BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 111
GILBERT AZ
85296-4202
US

IV. Provider business mailing address

3803 E LINCOLN HWY
MERRILLVILLE IN
46410-5809
US

V. Phone/Fax

Practice location:
  • Phone: 480-299-5177
  • Fax: 312-268-5389
Mailing address:
  • Phone: 219-791-9200
  • Fax: 312-268-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SUMESH SAXENA
Title or Position: OWNER
Credential: CP, BOCO
Phone: 219-791-9200