Provider Demographics
NPI:1154379659
Name:HECK, MICHAEL JAMES (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:HECK
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 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7685 WINCHESTER RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2202
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-759-4746
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12295207X00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00000040294OtherTLC
AR110318002Medicaid
TN2215714OtherCIGNA
TN3036286Medicaid
MS7187860Medicaid
MS620819926OtherBCBS
TN620819926OtherAETNA
TN620819926OtherCIGNA
TN620819926OtherTRICARE
AR161970001Medicaid
TN4132962OtherBCBS
TN5009375OtherAETNA
TN3371161Medicaid
MS08337886Medicaid
TNP00342511OtherRAILROAD MEDICARE
TN620819926OtherTRICARE
TN3371161Medicaid
AR110318002Medicaid