Individual
ERICA MAMAUAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 E CHESTNUT ST # 4B, LOUISVILLE, KY 40202-1713
(502) 588-3600
(502) 588-9536
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
59655
KY
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
59655
KY
390200000X
Student in an Organized Health Care Education/Training Program
MD475044
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59655
STATE LICENSE
KY
Enumeration date
04/06/2017
Last updated
03/24/2025
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