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General NPI Number Information
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NPI Number | 1235360165
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Entity Type | Individual
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Provider Name | AVIDA NUBIA BUSSELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 433 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-1155
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Country | US
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Telephone | 312-488-0040
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Fax | 708-719-2922
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Provider Business Mailing Address
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Address Line | 22615 HUNTERS TRL
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City | FRANKFORT
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State | IL
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Zip | 60423-6001
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Country | US
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Telephone | 773-981-8609
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Fax | 708-719-2922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 125.05539
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License Number State | IL
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