Healthcare Provider Details

I. General information

NPI: 1184334930
Provider Name (Legal Business Name): BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W GRANADA BLVD STE 3
ORMOND BEACH FL
32174-8104
US

IV. Provider business mailing address

3803 E LINCOLN HWY
MERRILLVILLE IN
46410-5809
US

V. Phone/Fax

Practice location:
  • Phone: 386-258-0401
  • Fax: 386-252-1013
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:
Phone: 219-791-9200