| Black Clover Holdings Llc | |
| 7225 Heritage Square Dr Ste 240 Granger IN 46530-5646 | |
| (574) 369-9102 | |
| Not Available | 
| Full Name | Black Clover Holdings Llc | 
|---|---|
| Speciality | General Practice | 
| Location | 7225 Heritage Square Dr Ste 240, Granger, Indiana | 
| Authorized Official Name and Position | Joshua M Lederer (PARTNER) | 
| Authorized Official Contact | 5743699102 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Black Clover Holdings Llc 54863 Northbridge West Ct Osceola IN 46561-1309 Ph: (574) 369-9102 | Black Clover Holdings Llc 7225 Heritage Square Dr Ste 240 Granger IN 46530-5646 Ph: (574) 369-9102 | 
| NPI Number | 1063397867 | 
|---|---|
| Provider Enumeration Date | 08/11/2025 | 
| Last Update Date | 08/11/2025 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1063397867 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary | 
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