Provider Demographics
NPI:1598192270
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:219-840-5595
Mailing Address - Street 1:3803 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5809
Mailing Address - Country:US
Mailing Address - Phone:219-791-9200
Mailing Address - Fax:219-979-6775
Practice Address - Street 1:1200 S WOODLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7383
Practice Address - Country:US
Practice Address - Phone:219-221-6119
Practice Address - Fax:219-979-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6120130003Medicare NSC
IN200901490Medicaid