Provider Demographics
NPI:1174712368
Name:MONROE BIOTECHNOLOGY, INC.
Entity type:Organization
Organization Name:MONROE BIOTECHNOLOGY, INC.
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:
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:
Practice Address - Street 1:3315 N BALLARD RD STE A
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8499
Practice Address - Country:US
Practice Address - Phone:920-738-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONROE BIOTECHNOLOGY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41783500Medicaid
WI0195720002Medicare NSC