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General NPI Number Information
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NPI Number | 1427921295
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Entity Type | Organization
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Legal Business Name | THE MODERN EXPERIENCE CLINIC
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 13792 REIMER DR N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-2219
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Country | US
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Telephone | 763-464-9061
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Fax | 763-333-7174
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Provider Business Mailing Address
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Address Line | 13792 REIMER DR N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-2219
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Country | US
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Telephone | 763-464-9061
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Fax | 763-333-7174
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DANIEL FALVEY
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Credential | MD
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Telephone | 763-464-9061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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