Provider Demographics
NPI:1790495547
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:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-791-9200
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:312-268-5389
Practice Address - Street 1:9921 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6174
Practice Address - Country:US
Practice Address - Phone:954-447-7779
Practice Address - Fax:312-268-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier