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General NPI Number Information
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NPI Number | 1548243678
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Entity Type | Individual
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Provider Name | JOHN R WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1440 W NORTH AVE STE 304
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City | MELROSE PARK
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State | IL
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Zip | 60160-1426
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Country | US
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Telephone | 708-681-7879
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Fax | 708-681-7886
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Provider Business Mailing Address
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Address Line | 1440 W NORTH AVE STE 304
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City | MELROSE PARK
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State | IL
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Zip | 60160-1426
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Country | US
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Telephone | 708-681-7879
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Fax | 708-681-7886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036088430
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 036088430
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 036088430
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License Number State | IL
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