MEDICARE: BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1245940097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC

Provider Business Mailing Address
First Line	:	3803 E LINCOLN HWY
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5809
Country	:	US
Telephone Number	:	219-791-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 E WALKER ST
Second Line	:
City	:	EAST FLAT ROCK
State	:	NC
Zip	:	28726-2235
Country	:	US
Telephone Number	:	828-595-9371
Fax Number	:	828-595-9373

Authorized Official
Title or Position	:	OWNER
Name	:	SUMESH SAXENA
Credential	:
Telephone Number	:	219-791-9200

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	12/02/2022

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