Clinton Lariscy, IDC
NPI #1164736302 in Great Lakes, Illinois
Provider Information
- NPI Number
- 1164736302
- Entity Type
- Individual
- Name
- Clinton Lariscy, IDC
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Military Health Care Provider - Independent Duty Corpsman
- Credential
- IDC
- Enumeration Date
- Jul 29, 2010
- Last Updated
- Jul 29, 2010
Practice Location
- Address
- 3355 ILLINOIS ST
- Address 2
- RECRUIT TRAINING COMMAND GREAT LAKES
- City
- Great Lakes
- State
- Illinois
- ZIP Code
- 60088
- Phone
- (847) 688-4643
Specialties & Taxonomy Codes
| Specialty |
|---|
| Military Health Care Provider - Independent Duty Corpsman — Independent Duty Corpsman |
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