Provider Demographics
NPI:1841811650
Name:GRZESKIEWICZ, ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:GRZESKIEWICZ
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 1:7932 HAYES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:COLDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14033-9704
Mailing Address - Country:US
Mailing Address - Phone:716-597-9307
Mailing Address - Fax:
Practice Address - Street 1:181 W MEADOW DR STE 400
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5058
Practice Address - Country:US
Practice Address - Phone:970-479-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0074726207XX0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery