MEDICARE: THE MODERN EXPERIENCE CLINIC LLC

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
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1427921295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MODERN EXPERIENCE CLINIC LLC

Provider Business Mailing Address
First Line	:	13792 REIMER DR N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2219
Country	:	US
Telephone Number	:	763-464-9061
Fax Number	:	763-333-7174

Provider Business Practice Location Address
First Line	:	13792 REIMER DR N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2219
Country	:	US
Telephone Number	:	763-464-9061
Fax Number	:	763-333-7174

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DANIEL FALVEY
Credential	:	MD
Telephone Number	:	763-464-9061

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	12/15/2025

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