Healthcare Provider Details

I. General information

NPI: 1154492312
Provider Name (Legal Business Name): JOSEPH J ECKBURG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 CRIMSON RIDGE DR STE 3
ROCKFORD IL
61107-6213
US

IV. Provider business mailing address

7117 CRIMSON RIDGE DR STE 3
ROCKFORD IL
61107-6213
US

V. Phone/Fax

Practice location:
  • Phone: 815-316-8700
  • Fax: 310-356-4935
Mailing address:
  • Phone: 815-316-8700
  • Fax: 310-356-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number036095243
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036095243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: