Healthcare Provider Details

I. General information

NPI: 1013182971
Provider Name (Legal Business Name): BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 CONNECTICUT STREET SUITE E
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

3803 E LINCOLN HWY
MERRILLVILLE IN
46410-5809
US

V. Phone/Fax

Practice location:
  • Phone: 219-791-9200
  • Fax: 219-979-6775
Mailing address:
  • Phone: 219-791-9200
  • Fax: 219-979-6775

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: MR. SUMESH SAXENA
Title or Position: PRESIDENT
Credential: C.P., BOCO
Phone: 219-840-5595