OrganizationActive
Modern Ketamine Clinic
NPI 1386366532 · Infusion Therapy Clinic/Center · Maple Grove, MN
Provider details
- NPI number
- 1386366532
- Entity type
- Organization
- Primary specialty
- Infusion Therapy Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Daniel Falvey, MD(763) 347-2100
Specialties & taxonomies
Ambulatory Health Care Facilities
- Multi-Specialty Clinic/Center261QM1300X
Ambulatory Health Care Facilities
Practice location
13792 Reimer Dr N
Maple Grove, MN 55311-2219
Phone: (763) 347-2100
Fax: (763) 333-7174
Approximate (ZIP-level) locationGet directions
Mailing address
13792 Reimer Dr N
Maple Grove, MN 55311-2219
Registry dates
- Enumerated
- 2022-09-14
- Last updated
- 2025-05-28
- Certified
- 2025-05-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.