Provider Demographics
NPI:1730132663
Name:NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, AND SLEEP MEDICINE, P.C.
Entity type:Organization
Organization Name:NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, AND SLEEP MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-681-7879
Mailing Address - Street 1:1440 W NORTH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1426
Mailing Address - Country:US
Mailing Address - Phone:708-681-7879
Mailing Address - Fax:708-681-7886
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE #608
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211496Medicare PIN