Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Black Clover Holdings LLC

Organization General Practice Physician · NPI 1063397867

Black Clover Holdings LLC is a General Practice Physician in Granger, Indiana. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

7225 Heritage Square Dr Ste 240
Granger, IN 46530-5646
Phone: (574) 369-9102
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X

Record details

NPI number1063397867
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Joshua Lederer — Partner · (574) 369-9102
Other names Medi Weight Loss Mishawaka
NPI enumeratedAugust 11, 2025
Last updated in NPPESAugust 11, 2025
Certification dateAugust 10, 2025
Mailing address54863 Northbridge West Ct, Osceola, IN 46561-1309