Provider Demographics
NPI:1275112864
Name:MARTINEZ LICHA, CARLOS RISIK (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RISIK
Last Name:MARTINEZ LICHA
Suffix:
Gender:M
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:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M
Mailing Address - Street 2:INTERNAL MEDICINE RESIDENCY, 3551 ROGER BROOKE DR.
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-5000
Mailing Address - Fax:210-916-2077
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M
Practice Address - Street 2:INTERNAL MEDICINE RESIDENCY, 3551 ROGER BROOKE DR.
Practice Address - City:JBSA-FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-5000
Practice Address - Fax:210-916-2077
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159487207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice