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General NPI Number Information
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NPI Number | 1730132663
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Entity Type | Organization
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Legal Business Name | NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, AND SLEEP MEDICINE, P.C.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 09/18/2025
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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 | PRESIDENT
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Name | JOHN R WILSON
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Credential |
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Telephone | 708-681-7879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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