David Dennis Dereczyk, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001252 Issued in MI

Practice address

2799 W Grand Blvd
Detroit, MI 48202-2608

Phone

(313) 916-1557

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: ddereczyk13092@direct.hfhs.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720158223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30746 COUNTRY RIDGE CIR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483311107",
            "telephone_number": "248-788-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERECZYK",
        "first_name": "DAVID",
        "middle_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "001252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talal M Derani, M.D.
• Sam Dercon, MD
• Aimee H Dereczyk, MD
• Amy Dereczyk, PA-C
• Darlene Caryn Dereczyk, ACNP-BC
• Michael Derevensky, MD
• Aftab Ahmed Dero, MD
• Simmone Cora Arielle Derouen
• Brittany Nicole Derr
• Carol Lynn Derr, M.A.

• Medical Physician Assistant in Detroit, MI
• Providers in Detroit, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.