Provider Demographics
NPI:1366476897
Name:MARTINEZ, CARLOS LUIS II (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:LUIS
Last Name:MARTINEZ
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1447
Mailing Address - Country:US
Mailing Address - Phone:716-668-6146
Mailing Address - Fax:716-668-8325
Practice Address - Street 1:2291 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1447
Practice Address - Country:US
Practice Address - Phone:716-668-6146
Practice Address - Fax:716-668-8325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160093207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01036382Medicaid
NYE15849Medicare UPIN
NY01036382Medicaid