Healthcare Provider Details

I. General information

NPI: 1053623884
Provider Name (Legal Business Name): WESLEY UPDIKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15495 N 247 RD
OKMULGEE OK
74447-7969
US

IV. Provider business mailing address

15495 N 247 RD
OKMULGEE OK
74447-7969
US

V. Phone/Fax

Practice location:
  • Phone: 918-733-1351
  • Fax: 866-611-2680
Mailing address:
  • Phone: 918-733-1351
  • Fax: 866-611-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34806
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR0668
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01071413A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34806
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29066
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036172469
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR0668
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.208189
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: