MEDICARE: NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, AND SLEEP MEDICINE, P.C.

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	174400000X	Specialist		IL

General Provider Information

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

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	:	PRESIDENT
Name	:	JOHN R WILSON
Credential	:
Telephone Number	:	708-681-7879

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	09/18/2025

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