Provider Demographics
NPI:1174109706
Name:ECCLES, JACOB DAVID (MD, PHD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DAVID
Last Name:ECCLES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W TAYLOR STREET
Mailing Address - Street 2:SUITE 3C, LUNG HEALTH-PULMONOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-3300
Mailing Address - Fax:585-207-8349
Practice Address - Street 1:1801 W TAYLOR STREET
Practice Address - Street 2:SUITE 3C, LUNG HEALTH-PULMONOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-3300
Practice Address - Fax:312-996-3896
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.166977390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program