Provider Demographics
NPI:1093159634
Name:SMITH-BRONSTEIN, VIRGINIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ANN
Last Name:SMITH-BRONSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN STE 101
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3032
Mailing Address - Country:US
Mailing Address - Phone:630-789-3110
Mailing Address - Fax:
Practice Address - Street 1:11 SALT CREEK LN STE 101
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3032
Practice Address - Country:US
Practice Address - Phone:630-789-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148473207Y00000X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology