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General NPI Number Information
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NPI Number | 1447202122
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Entity Type | Individual
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Provider Name | JENNY H PETKOVA MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 6550 FANNIN ST STE 1000
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City | HOUSTON
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State | TX
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Zip | 77030-2717
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Country | US
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Telephone | 713-865-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 6550 FANNIN SMITH TOWER SUITE 1001
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City | HOUSTON
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State | TX
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Zip | 77030
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Country | US
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Telephone | 713-441-1111
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 48256
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | C10010924
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License Number State | DE
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