Healthcare Provider Details

I. General information

NPI: 1225811631
Provider Name (Legal Business Name): LOGAN T HECK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N CLARK ST STE 310
CHICAGO IL
60610-5413
US

IV. Provider business mailing address

20706 CARDINAL CT
FRANKFORT IL
60423-3106
US

V. Phone/Fax

Practice location:
  • Phone: 312-620-1803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009787
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: