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NPI Code Detail

MEDICARE: DR. HALLE MARIE TYCZKOWSKI

MEDICARE: DR. HALLE MARIE TYCZKOWSKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianXXXXNM

General Provider Information

NPI Number : 1013859933
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HALLE MARIE TYCZKOWSKI
Provider Business Mailing Address
First Line : 2211 LOMAS BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-2719
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2211 LOMAS BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-2719
Country : US
Telephone Number : 505-272-2111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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