Healthcare Provider Details

I. General information

NPI: 1174109706
Provider Name (Legal Business Name): JACOB DAVID ECCLES MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR STREET SUITE 3C, LUNG HEALTH-PULMONOLOGY
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1801 W TAYLOR STREET SUITE 3C, LUNG HEALTH-PULMONOLOGY
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-3300
  • Fax: 312-996-3896
Mailing address:
  • Phone: 312-996-3300
  • Fax: 585-207-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036.166977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: