Healthcare Provider Details

I. General information

NPI: 1205026093
Provider Name (Legal Business Name): MILTON KYLE SMOOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD SUITE 125
LEXINGTON KY
40504-3504
US

IV. Provider business mailing address

740 S LIMESTONE ST SUITE K-401
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-3131
  • Fax: 859-323-2412
Mailing address:
  • Phone: 859-218-3065
  • Fax: 859-257-8696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41039
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number41039
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: