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General NPI Number Information
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NPI Number | 1245425032
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Entity Type | Individual
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Provider Name | MARISSA GROTZKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 615 ARAPEEN DR SUITE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1267
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Country | US
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Telephone | 801-587-3969
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Fax | 801-587-3997
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Provider Business Mailing Address
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Address Line | 615 S ARAPEEN DR STE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1239
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Country | US
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Telephone | 801-587-3969
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Fax | 801-587-3997
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 5525882-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 95568
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License Number State | SC
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