Provider Demographics
NPI:1558735282
Name:PETKOVSKA, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:PETKOVSKA
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 1:3333 BURNET AVE, ML 2008
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-7966
Mailing Address - Fax:636-513-7967
Practice Address - Street 1:3333 BURNET AVE, ML 2008
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-7966
Practice Address - Fax:636-513-7967
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68264208000000X
OH35.1447662080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics