Healthcare Provider Details

I. General information

NPI: 1073544755
Provider Name (Legal Business Name): PAUL F UPDIKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

2157 MAIN ST
BUFFALO NY
14214-2648
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-8550
  • Fax: 716-893-4020
Mailing address:
  • Phone: 716-893-8550
  • Fax: 716-893-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number211389
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number211389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: