# LIBERTY STAR MEDICAL LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184973877
- **Authorized official:** DR. DAVID BRIAN GATTUSO SR. MD (PHYSICIAN)
- **Authorized official phone:** (608) 563-4213

## Contact information

- **Practice address:** 1905 CENTER AVE, SUITE 5, JANESVILLE, WI 53546-2842
- **Practice address phone:** (608) 563-4213
- **Practice address fax:** (866) 998-1030
- **Mailing address:** 1905 CENTER AVE, SUITE 5, JANESVILLE, WI 53546-2842
- **Mailing address phone:** (608) 295-3670
- **Mailing address fax:** (866) 998-1030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 27454-20 | WI | Yes |

## Other

- **Enumeration date:** 09/10/2012
- **Last updated:** 09/20/2012