Provider Demographics
NPI:1821364043
Name:HECK, MICHAEL KUBELIK (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KUBELIK
Last Name:HECK
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1410 INCARNATION DR STE 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-5708
Mailing Address - Country:US
Mailing Address - Phone:434-260-1296
Mailing Address - Fax:844-804-3071
Practice Address - Street 1:1410 INCARNATION DR STE 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5708
Practice Address - Country:US
Practice Address - Phone:434-260-1296
Practice Address - Fax:844-804-3071
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01022039412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102203941OtherVIRGINIA BOARD OF MEDICINE