Healthcare Provider Details

I. General information

NPI: 1730823162
Provider Name (Legal Business Name): PEARLS OF VEDA MEDICAL AND HOLISTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W 95TH ST
CHICAGO IL
60628-1155
US

IV. Provider business mailing address

433 W 95TH ST
CHICAGO IL
60628-1155
US

V. Phone/Fax

Practice location:
  • Phone: 708-879-3043
  • Fax: 708-719-2922
Mailing address:
  • Phone: 773-981-8609
  • Fax: 708-719-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AVIDA NUBIAN BUSSELL
Title or Position: CLINICIAN/OWNER
Credential:
Phone: 708-879-3043