| Organization Name: | HEALTHSTAT ONSITE CLINIC- FOUR WINDS CASINO |
| NPI Number: | 1770997850 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WARREN HUTTON (COO) |
| Mailing Address: | 11111 Wilson Rd New Buffalo |
| State: | MI US |
| Postal Code: | 491178888 |
| Phone Number: | 2692965259 |
| Fax Number: | |
| NPI Enumeration Date: | 06/17/2014 |
| NPI Last Update Date: | 06/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2083P0500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Preventive Medicine |
| Taxonomy Specialization: | Preventive Medicine/Occupational Environmental Medicine |
| Taxonomy Definition: | A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |