Healthcare Provider Details

I. General information

NPI: 1700445756
Provider Name (Legal Business Name): MICHAEL JOHN REYNOLDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD STE 101
WILMINGTON DE
19808-5413
US

IV. Provider business mailing address

1941 LIMESTONE RD STE 101
WILMINGTON DE
19808-5413
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-9494
  • Fax: 302-691-1478
Mailing address:
  • Phone: 302-655-9494
  • Fax: 302-691-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC1-0029922
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: