Healthcare Provider Details

I. General information

NPI: 1750887519
Provider Name (Legal Business Name): RACHEL GROETSCH BUCK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 W WHISPERING WIND DR
PHOENIX AZ
85085-2853
US

IV. Provider business mailing address

15650 N BLACK CANYON HWY STE 100
PHOENIX AZ
85053-4068
US

V. Phone/Fax

Practice location:
  • Phone: 623-869-9080
  • Fax: 623-869-9090
Mailing address:
  • Phone: 602-866-0550
  • Fax: 602-993-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number009059
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: