Healthcare Provider Details

I. General information

NPI: 1841811650
Provider Name (Legal Business Name): ELISE GRZESKIEWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E 1500 S STE 103
HEBER CITY UT
84032-3940
US

IV. Provider business mailing address

900 ROUND VALLEY DR STE 100
PARK CITY UT
84060-7552
US

V. Phone/Fax

Practice location:
  • Phone: 435-655-6600
  • Fax: 435-655-2388
Mailing address:
  • Phone: 435-655-6600
  • Fax: 435-655-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberDR.0074726
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number14278995-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: