Organization
BLACK CLOVER HOLDINGS LLC
Active
Other names
Medi Weight Loss Mishawaka
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA M LEDERER (PARTNER)
(574) 369-9102
Entity
Organization
Contact information
Practice address
7225 HERITAGE SQUARE DR STE 240, GRANGER, IN 46530-5646
(574) 369-9102
Mailing address
54863 NORTHBRIDGE WEST CT, OSCEOLA, IN 46561-1309
(574) 369-9102
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/11/2025
Last updated
08/11/2025
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