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NPI Code Detail

MEDICARE: VEDA MEDICAL AND CONSULTING RESEARCH

MEDICARE: VEDA MEDICAL AND CONSULTING RESEARCH
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
1171400000XHealth & Wellness Coach
21744R1102XResearch Study Specialist
3207P00000XEmergency Medicine Physician
4207Q00000XFamily Medicine Physician
52083A0300XAddiction Medicine (Preventive Medicine) Physician
6251E00000XHome Health Agency
7261QC1500XCommunity Health Clinic/Center
8405300000XPrevention Professional
92083B0002XObesity Medicine (Preventive Medicine) Physician
10261QH0100XHealth Service Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036.129396OTHERILSTATE OF ILLINOIS

General Provider Information

NPI Number : 1770243412
Entity Type Code : Organization
Provider Name (Legal Business Name) : VEDA MEDICAL AND CONSULTING RESEARCH
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 :
Provider Business Practice Location Address
First Line : 8801 S STONY ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2810
Country : US
Telephone Number : 708-586-9798
Fax Number :
Authorized Official
Title or Position : MEMBER/EMPLOYEE/DIRECTOR
Name : DR. AVIDA BUSSELL
Credential : MD
Telephone Number : 708-981-8609
Provider Enumeration Date : 12/21/2021
Last Update Date : 12/21/2021

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Directions to “VEDA MEDICAL AND CONSULTING RESEARCH ” Practice Location

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