MEDICARE: PEARLS OF VEDA MEDICAL AND HOLISTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	251E00000X	Home Health Agency
3	261QH0100X	Health Service Clinic/Center
4	202D00000X	Integrative Medicine Physician
5	261QU0200X	Urgent Care Clinic/Center
6	2083B0002X	Obesity Medicine (Preventive Medicine) Physician
7	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1730823162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLS OF VEDA MEDICAL AND HOLISTIC

Provider Business Mailing Address
First Line	:	22615 HUNTERS TRL
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-6001
Country	:	US
Telephone Number	:	773-981-8609
Fax Number	:	708-719-2922

Provider Business Practice Location Address
First Line	:	433 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-1155
Country	:	US
Telephone Number	:	708-879-3043
Fax Number	:	708-719-2922

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. AVIDA NUBIAN BUSSELL
Credential	:	M.D.
Telephone Number	:	708-879-3043

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	01/15/2026

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