Provider Demographics
NPI:1023411303
Name:BIONICARE PROSTHETICS AND ORTHOTICS, LLC
Entity type:Organization
Organization Name:BIONICARE PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:<UNAVAIL>
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: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 1:9501 W 144TH PL STE 304
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2564
Practice Address - Country:US
Practice Address - Phone:708-966-2850
Practice Address - Fax:219-979-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier