Active NPI
Deangelo Derek Reynolds Sr., MD
- Pediatric Dermatology Physician
- Detroit, MI
National Provider Identifier
1821970336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dermatology Physician
- License
- 6456775557
- Practice address
- 3825 D Oris St
Detroit, MI 48238 - Phone
- (656) 667-6653
- NPI assigned
- Jul 24, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dermatology Physician | 207NP0225X | 6456775557 | MI | Primary |
Addresses
Primary practice location
3825 D Oris St
Detroit, MI 48238
Mailing address
3825 D Oris St
Detroit, MI 48238
Phone (656) 667-6653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6456775557 | MI | MD | Pediatric Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753315200000",
"number": "1821970336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3825 D ORIS ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "48238",
"telephone_number": "656-667-6653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3825 D ORIS ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "48238",
"telephone_number": "656-667-6653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "DEANGELO",
"middle_name": "DEREK",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-24",
"last_updated": "2025-07-24",
"certification_date": "2025-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207NP0225X",
"taxonomy_group": "",
"desc": "Dermatology, Pediatric Dermatology",
"state": "MI",
"license": "6456775557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.