Provider Demographics
NPI:1326335514
Name:BRENT, EVORA JUANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVORA
Middle Name:JUANITA
Last Name:BRENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVORA
Other - Middle Name:JUANITA
Other - Last Name:NEWBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2650 RIDGE AVE ROOM 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:1000 CENTRAL ST.
Practice Address - Street 2:SUITE 800
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1780
Practice Address - Country:US
Practice Address - Phone:847-570-2577
Practice Address - Fax:847-733-5424
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361382742080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics