Provider Demographics
NPI:1831355346
Name:PODJASEK, JENNA C (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:C
Last Name:PODJASEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:C
Other - Last Name:PETSCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6320 159TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2776
Mailing Address - Country:US
Mailing Address - Phone:708-687-3855
Mailing Address - Fax:708-444-2324
Practice Address - Street 1:6320 159TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2776
Practice Address - Country:US
Practice Address - Phone:708-687-3855
Practice Address - Fax:708-444-2324
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52031207R00000X, 207K00000X
IL036-133212207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine