Provider Demographics
NPI:1043017288
Name:MOTEN, SKYE
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:
Last Name:MOTEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MARSEILLES ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1324
Mailing Address - Country:US
Mailing Address - Phone:137-423-1833
Mailing Address - Fax:248-569-9151
Practice Address - Street 1:23077 GREENFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3750
Practice Address - Country:US
Practice Address - Phone:313-824-1000
Practice Address - Fax:248-569-9151
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker