=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477911550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2016
-----------------------------------------------------
Last Update Date | 09/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 RED COACH DR STE D
-----------------------------------------------------
City | MISHAWAKA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46545-8324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-855-3744
-----------------------------------------------------
Fax | 574-485-2406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3803 E LINCOLN HWY
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-5809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-791-9200
-----------------------------------------------------
Fax | 219-979-6775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. SUMESH SAXENA
-----------------------------------------------------
Credential | C.P., BOCO
-----------------------------------------------------
Telephone | 219-791-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------