Provider Demographics
NPI:1861457889
Name:SMOOT, CARL ASHLEY (DO,FCCP, DABSM)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ASHLEY
Last Name:SMOOT
Suffix:
Gender:M
Credentials:DO,FCCP, DABSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3639
Mailing Address - Country:US
Mailing Address - Phone:906-779-7050
Mailing Address - Fax:906-774-3325
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-779-7050
Practice Address - Fax:906-774-3325
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS006908207RP1001X
MICS006903207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871663443OtherGROUP NPI
MIP39080001OtherMEDICARE INDIVIDUAL PIN
WI30057800Medicaid
MI1861457889OtherINDIVIDUAL NPI
MI2712724Medicaid
MI5220016OtherMEDICARE PIN PRIOR 2007
MIOP39080OtherMEDICARE GROUP PIN
MI1871663443OtherGROUP NPI