Healthcare Provider Details

I. General information

NPI: 1730132663
Provider Name (Legal Business Name): NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, AND SLEEP MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W NORTH AVE STE 304
MELROSE PARK IL
60160-1426
US

IV. Provider business mailing address

1440 W NORTH AVE STE 304
MELROSE PARK IL
60160-1426
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-7879
  • Fax: 708-681-7886
Mailing address:
  • Phone: 708-681-7879
  • Fax: 708-681-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: JOHN R WILSON
Title or Position: PRESIDENT
Credential:
Phone: 708-681-7879