Provider Demographics
NPI:1801837612
Name:MACHICAO, VICTOR I (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:I
Last Name:MACHICAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:ILICH
Other - Last Name:MACHICAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 4.234
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6677
Mailing Address - Fax:713-500-6699
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-704-3450
Practice Address - Fax:713-704-6850
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4564207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259760800Medicaid
G93814Medicare UPIN
FL259760800Medicaid