Healthcare Provider Details

I. General information

NPI: 1164384210
Provider Name (Legal Business Name): AAA MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7069 TAYLORSVILLE RD STE G
HUBER HEIGHTS OH
45424-3184
US

IV. Provider business mailing address

2753 BLUEFLAG ST
TIPP CITY OH
45371-2584
US

V. Phone/Fax

Practice location:
  • Phone: 937-216-5165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: POLAT SHAKAROV
Title or Position: OWNER
Credential:
Phone: 443-838-6240