MEDICARE: DR. JOHN R WILSON MD

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	2084N0400X	Neurology Physician	036088430	IL
2	2084N0600X	Clinical Neurophysiology Physician	036088430	IL
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	036088430	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1635130	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548243678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R WILSON MD

Provider Business Mailing Address
First Line	:	1440 W NORTH AVE STE 304
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1426
Country	:	US
Telephone Number	:	708-681-7879
Fax Number	:	708-681-7886

Provider Business Practice Location Address
First Line	:	1440 W NORTH AVE STE 304
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1426
Country	:	US
Telephone Number	:	708-681-7879
Fax Number	:	708-681-7886

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/30/2025

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