Provider Demographics
NPI:1316191976
Name:LANG, BROOK YUKNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOK
Middle Name:YUKNIS
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BROOK
Other - Middle Name:ANN
Other - Last Name:YUKNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:2003 KOOTENAI HEALTH WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-625-5185
Practice Address - Fax:208-625-5892
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM148632080N0001X
WAMD604146872080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine