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	:	1982314738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 2300
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46384-2300
Country	:	US
Telephone Number	:	219-791-9200
Fax Number	:	312-268-5389

Provider Business Practice Location Address
First Line	:	15301 SPECTRUM DR STE 175
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-6441
Country	:	US
Telephone Number	:	972-980-9660
Fax Number	:	972-980-9313

Authorized Official
Title or Position	:	OWNER
Name	:	SUMESH SAXENA
Credential	:
Telephone Number	:	219-840-5595

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	06/02/2026

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