Provider Demographics
NPI:1245425032
Name:GROTZKE, MARISSA (MD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GROTZKE
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 1:615 ARAPEEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1267
Mailing Address - Country:US
Mailing Address - Phone:801-587-3969
Mailing Address - Fax:801-587-3997
Practice Address - Street 1:615 ARAPEEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1267
Practice Address - Country:US
Practice Address - Phone:801-587-3969
Practice Address - Fax:801-587-3997
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5525882-1205207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism