Provider Demographics
NPI:1447202122
Name:PETKOVA, JENNY H (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:H
Last Name:PETKOVA
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:PO BOX 12210
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19850
Mailing Address - Country:US
Mailing Address - Phone:302-737-7700
Mailing Address - Fax:302-737-5407
Practice Address - Street 1:6550 FANNIN ST STE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-865-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48256207R00000X
DEC10010924207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34659600Medicaid
008806261JOtherHUMANA
0098R73601Medicare ID - Type Unspecified
WI34659600Medicaid