MEDICARE: GLENDA M UPDYKE MS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.001269	OH
2	363AS0400X	Surgical Physician Assistant	50001269	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174582597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA M UPDYKE MS PA-C

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL STE 550
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-6115
Country	:	US
Telephone Number	:	937-762-1310
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-3384
Country	:	US
Telephone Number	:	937-395-6665
Fax Number	:	937-395-6668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/16/2026

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