Provider Demographics
NPI:1679921845
Name:MENKE, LILIBETH GIRALDO (DO)
Entity type:Individual
Prefix:DR
First Name:LILIBETH
Middle Name:GIRALDO
Last Name:MENKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LILIBETH
Other - Middle Name:NATALIE
Other - Last Name:GIRALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8787 BRYAN DAIRY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1259
Mailing Address - Country:US
Mailing Address - Phone:727-391-6296
Mailing Address - Fax:813-635-7940
Practice Address - Street 1:8787 BRYAN DAIRY RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1259
Practice Address - Country:US
Practice Address - Phone:727-391-6296
Practice Address - Fax:813-635-7940
Is Sole Proprietor?:No
Enumeration Date:2016-05-29
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16149207Q00000X
FLUO4904207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104076200Medicaid