Provider Demographics
NPI:1730823162
Name:PEARLS OF VEDA MEDICAL AND HOLISTIC SPA. LLC
Entity type:Organization
Organization Name:PEARLS OF VEDA MEDICAL AND HOLISTIC SPA. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIDA
Authorized Official - Middle Name:NUBIA
Authorized Official - Last Name:BUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-586-9798
Mailing Address - Street 1:22615 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-6001
Mailing Address - Country:US
Mailing Address - Phone:773-981-8609
Mailing Address - Fax:
Practice Address - Street 1:433 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1155
Practice Address - Country:US
Practice Address - Phone:708-879-3043
Practice Address - Fax:855-640-4865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARLS OF VEDA MEDICAL AND HOLISTIC SPA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-22
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty