Healthcare Provider Details

I. General information

NPI: 1699152454
Provider Name (Legal Business Name): GRACE LEE BANIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GRACE MYUNG LEE

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA182376
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD473043
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.152400
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMT220064
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: