IndividualActive
Clinton Lariscy, IDC
NPI 1164736302 · Independent Duty Corpsman · Great Lakes, IL
Provider details
- NPI number
- 1164736302
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- IDC
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Other Service Providers
Practice location
3355 Illinois St
Recruit Training Command Great Lakes
Great Lakes, IL 60088
Phone: (847) 688-4643
Approximate (ZIP-level) locationGet directions
Mailing address
3355 Illinois St
Great Lakes, IL 60088
Registry dates
- Enumerated
- 2010-07-29
- Last updated
- 2010-07-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.