MEDICARE: DR. VIRGINIA ANN SMITH-BRONSTEIN M.D.

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	207Y00000X	Otolaryngology Physician	036148473	IL
2	207Y00000X	Otolaryngology Physician	C207094	CA
3	207Y00000X	Otolaryngology Physician	81253	MN

General Provider Information

NPI Number	:	1093159634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA ANN SMITH-BRONSTEIN M.D.

Provider Business Mailing Address
First Line	:	11 SALT CREEK LN STE 101
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3032
Country	:	US
Telephone Number	:	630-789-3110
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 NORTHGATE DR STE 110
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3664
Country	:	US
Telephone Number	:	415-362-5443
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	02/02/2026

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