Healthcare Provider Details

I. General information

NPI: 1639061385
Provider Name (Legal Business Name): BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 EAGLE CREEK PKWY STE A
INDIANAPOLIS IN
46254-4690
US

IV. Provider business mailing address

8695 CONNECTICUT ST STE E
MERRILLVILLE IN
46410-6240
US

V. Phone/Fax

Practice location:
  • Phone: 317-824-9990
  • Fax: 317-342-5836
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: LAURA ALLEN
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 336-339-9671