Healthcare Provider Details

I. General information

NPI: 1629788476
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: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 WESTBROOK PLAZA DR STE 230
WINSTON-SALEM NC
27103-3068
US

IV. Provider business mailing address

3803 E LINCOLN HWY
MERRILLVILLE IN
46410-5809
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-2425
  • Fax: 336-765-8370
Mailing address:
  • Phone: 219-791-9200
  • Fax:

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