# BLACK CLOVER HOLDINGS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medi Weight Loss Mishawaka
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063397867
- **Authorized official:** JOSHUA M LEDERER (PARTNER)
- **Authorized official phone:** (574) 369-9102

## Contact information

- **Practice address:** 7225 HERITAGE SQUARE DR STE 240, GRANGER, IN 46530-5646
- **Practice address phone:** (574) 369-9102
- **Mailing address:** 54863 NORTHBRIDGE WEST CT, OSCEOLA, IN 46561-1309
- **Mailing address phone:** (574) 369-9102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/11/2025
- **Last updated:** 08/11/2025