Organization
MODERN KETAMINE CLINIC
Active
Organization
MODERN KETAMINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL GREGORY FALVEY MD (MD)
(763) 347-2100
Entity
Organization
Contact information
Practice address
13792 REIMER DR N, MAPLE GROVE, MN 55311-2219
(763) 347-2100
(763) 333-7174
Mailing address
13792 REIMER DR N, MAPLE GROVE, MN 55311-2219
(763) 347-2100
(763) 333-7174
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
09/14/2022
Last updated
05/28/2025
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