Provider Demographics
NPI:1205026093
Name:SMOOT, MILTON KYLE (MD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:KYLE
Last Name:SMOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE ST
Mailing Address - Street 2:SUITE K-401
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-218-3065
Mailing Address - Fax:859-257-8696
Practice Address - Street 1:2195 HARRODSBURG RD
Practice Address - Street 2:SUITE 125
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3504
Practice Address - Country:US
Practice Address - Phone:859-218-3131
Practice Address - Fax:859-323-2412
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2015-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY41039207Q00000X, 207QS0010X
IA38350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923225Medicare PIN
IAP00784141Medicare PIN