Provider Demographics
NPI:1285144352
Name:BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Entity type:Organization
Organization Name:BIONIC PROSTHETICS AND ORTHOTICS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCO
Authorized Official - Phone:219-791-9200
Mailing Address - Street 1:8695 CONNECTICUT ST STE E
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6240
Mailing Address - Country:US
Mailing Address - Phone:219-791-9200
Mailing Address - Fax:219-979-6775
Practice Address - Street 1:1101 GLENDALE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3769
Practice Address - Country:US
Practice Address - Phone:219-791-9200
Practice Address - Fax:219-979-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier