Provider Demographics
NPI:1851594295
Name:KOVACH, JENNY DENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:DENTE
Last Name:KOVACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:MARIA
Other - Last Name:DENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:CHILDREN'S URGENT CARE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-266-2280
Mailing Address - Fax:414-266-1627
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:CHILDREN'S URGENT CARE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-266-2280
Practice Address - Fax:414-266-1627
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51707-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35281700Medicaid