Provider Demographics
NPI:1063759637
Name:O'CONNOR, BRENT STUART (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:STUART
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1019 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1307
Mailing Address - Country:US
Mailing Address - Phone:847-256-1908
Mailing Address - Fax:847-256-1909
Practice Address - Street 1:1019 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1307
Practice Address - Country:US
Practice Address - Phone:847-256-1908
Practice Address - Fax:847-256-1909
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036060746207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology