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General NPI Number Information
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NPI Number | 1851916217
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Entity Type | Organization
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Legal Business Name | BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 633 E RAY RD STE 111
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City | GILBERT
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State | AZ
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Zip | 85296-4202
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Country | US
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Telephone | 480-299-5177
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Fax | 312-268-5389
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Provider Business Mailing Address
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Address Line | 3803 E LINCOLN HWY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5809
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Country | US
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Telephone | 219-791-9200
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Fax | 312-268-5389
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Authorized Official
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Title or Position | OWNER
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Name | SUMESH SAXENA
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Credential | CP, BOCO
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Telephone | 219-791-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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