MEDICARE: AAA MEDICAL SUPPLY 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1164384210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAA MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	2753 BLUEFLAG ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2584
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2753 BLUEFLAG ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2584
Country	:	US
Telephone Number	:	410-302-3072
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	POLAT SHAKAROV
Credential	:
Telephone Number	:	443-838-6240

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	01/05/2026

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Directions to “AAA MEDICAL SUPPLY LLC ” Practice Location

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