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BLACK CLOVER HOLDINGS LLC
NPI 1063397867
General Practice in Granger, IN

Active since August 11, 2025
7225 HERITAGE SQUARE DR STE 240, GRANGER, IN 46530(574) 369-9102 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Black Clover Holdings Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACK CLOVER HOLDINGS LLC (NPI 1063397867), doing business as Medi Weight Loss Mishawaka, is a healthcare organization registered as a general practice in Granger, Indiana and active in the NPI registry since August 2025. The organization lists Joshua M Lederer, Partner, as its authorized official.

NPPES Registry Identity

NPI1063397867
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameBLACK CLOVER HOLDINGS LLC
Location Address7225 HERITAGE SQUARE DR STE 240Granger, IN 46530-5646
Mailing Address54863 Northbridge West CtOsceola, IN 46561-1309 · (574) 369-9102
Phone(574) 369-9102
Organization SubpartNo
Authorized OfficialJoshua M LedererPartner · (574) 369-9102
Enumeration DateAugust 11, 2025
NPPES CertifiedAugust 10, 2025
✔ NPI 1063397867 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
7225 HERITAGE SQUARE DR STE 240, Granger, IN 46530
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Other Names 1

Doing Business AsMedi Weight Loss Mishawaka

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Black Clover Holdings LLC's NPI number?

The NPI number for Black Clover Holdings LLC is 1063397867. It was assigned to this organization in the NPPES registry on August 11, 2025. The provider is doing business as Medi Weight Loss Mishawaka.

Where is Black Clover Holdings LLC located?

Black Clover Holdings LLC is located at 7225 Heritage Square Dr Ste 240, Granger, IN 46530. The listed phone number is (574) 369-9102.

What is Black Clover Holdings LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Black Clover Holdings LLC was last updated on August 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.