Provider Demographics
NPI:1124122825
Name:BANKAITIS, LEE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANNE
Last Name:BANKAITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LEGION RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-932-1171
Mailing Address - Fax:919-933-1377
Practice Address - Street 1:1717 LEGION RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2396
Practice Address - Country:US
Practice Address - Phone:919-932-1171
Practice Address - Fax:919-933-1377
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG85002Medicare UPIN