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	:	1871951038
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	:	219-979-6775

Provider Business Practice Location Address
First Line	:	4315 N. LINCOLN AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618
Country	:	US
Telephone Number	:	773-698-6269
Fax Number	:	219-979-6775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SUMESH SAXENA
Credential	:	C.P., BOCO
Telephone Number	:	219-840-5595

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	05/30/2019

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