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General NPI Number Information
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NPI Number | 1174109706
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Entity Type | Individual
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Provider Name | JACOB DAVID ECCLES MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1801 W TAYLOR STREET SUITE 3C, LUNG HEALTH-PULMONOLOGY
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-3300
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Fax | 312-996-3896
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Provider Business Mailing Address
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Address Line | 1801 W TAYLOR STREET SUITE 3C, LUNG HEALTH-PULMONOLOGY
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City | CHICAGO
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State | IL
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Zip | 60612-4325
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Country | US
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Telephone | 312-996-3300
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Fax | 585-207-8349
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 036.166977
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License Number State | IL
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